EMPLOYEE TIME-OFF REQUEST FORM

By filling out this form, you are requesting to be off from your normal daily responsibilities at OCC. You will be responsible for having your job covered and competently carried out by someone else in your absence. All requests will be reviewed but not guaranteed on the requested dates.

Name

First Name

Last Name

From Date

YYYY

To Date

YYYY

Total Number Days Off:

(Part-time employees: Sunday & Wednesday =full days, rest of working days =half days, Sabbaths=0)

Explanation for time off:

List any Special Events you will be missing:

Name of person who will be covering for you (if necessary)?

Person Covering has confirmed

Yes