Time Off Request Form - Go Further Group

Employee Name *

First

Last

Department *

Days/Hours off requested *

Reason

Please explain reason for time off request *

Acknowledgement

My signature certifies that I understand that I acknowledged and accepted the information about requesting time off for medical reasons or personal reasons. By signing this notification, I agree to adhere to the company policy.

Please note that you are required to return back to work on the day you have provided, therefore, in the event you are unable to return to work on that day, you are responsible to inform your supervisor or general manager immediately.

Signature *

For mobile phones, and tablets use your finger to draw your signature.

Supervisor's Email Address *

Please enter the email address to whom you want this request sent.

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