Log TimeOff

Associate Time Request Form

(Time Exchange, Time Off or Holiday / Vacation)

Assciate Last Name *

Associate First Name *

Department *

Pay *

Personal Time Off:

PTO Dates Requested *

PTO Dates Rqstd Through *

Exchange PTO Days *

For: *

Total PTO Hours Rqstd *

Pay Qualified *

Yes

No

Modify PTO Hours

For:

Reason / Explanation for/of Request *

Vacation Request:

Dates Requested:

Through

Exchange Days:

Exchange Days For:

Total Vacation Hrs Rqstd:

Pay Qualified

Yes

No

Modified Hours:

Modify Hours For:

Which Associates Have You Requested will be Handling Your Business on Your Behalf? *

List the Business they are Expected to Handle *

Print Associate Name: *

Date *