Request For Time Off Form
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Personal Information
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First Name
Last Name
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Your E-mail Address
A copy of this form will be sent to the e-mail address you provide.
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E-mail Address (of your Immediate Supervisor)
A copy of this form will be automatically e-mailed to the address provided.
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Tour Of Duty
Important Information:
1. Label the month that you are requesting "time-off."
2. Fill in the dates under the appropriate days.
3. Fill in your regular days off with the letter "R."
4. Fill in any Holidays with the letter"H."
5. Fill in the vacation, administrative leave and or comp days you are requesting.
6. Submit to your immediate supervisor for initial review (only).
7. Your supervisor will forward the request to the Director or his designee for approval.
It should be understood that your request is not approved until you receive written approval from the Director of Public Safety.
It shall be the responsibility of the employee to review the weekly schedule to ensure that it reflects the proper time off. Conflicts must be immediately brought to the attention of the Director's Office.
Requested Time Off
Date
Reason
Date
Reason
(1) Date Requested
Select:
R - Regular Day Off
V - Vacation
AL - Administrative Leave
H - Holiday
C - Comp Day
Select:
R - Regular Day
V - Vacation
AL - Administrative Leave
H - Holiday
C - Comp Day
(2) Date Requested
Select:
R - Regular Day Off
V - Vacation
AL - Administrative Leave
H - Holiday
C - Comp Day
Select:
R - Regular Day
V - Vacation
AL - Administrative Leave
H - Holiday
C - Comp Day
(3) Date Requested
Select:
R - Regular Day Off
V - Vacation
AL - Administrative Leave
H - Holiday
C - Comp Day
Select:
R - Regular Day
V - Vacation
AL - Administrative Leave
H - Holiday
C - Comp Day
(4) Date Requested
Select:
R - Regular Day Off
V - Vacation
AL - Administrative Leave
H - Holiday
C - Comp Day
Select:
R - Regular Day
V - Vacation
AL - Administrative Leave
H - Holiday
C - Comp Day
(5) Date Requested
Select:
R - Regular Day Off
V - Vacation
AL - Administrative Leave
H - Holiday
C - Comp Day
Select:
R - Regular Day
V - Vacation
AL - Administrative Leave
H - Holiday
C - Comp Day
(6) Date Requested
Select:
R - Regular Day Off
V - Vacation
AL - Administrative Leave
H - Holiday
C - Comp Day
Select:
R - Regular Day
V - Vacation
AL - Administrative Leave
H - Holiday
C - Comp Day
(7) Date Requested
Select:
R - Regular Day Off
V - Vacation
AL - Administrative Leave
H - Holiday
C - Comp Day
Select:
R - Regular Day
V - Vacation
AL - Administrative Leave
H - Holiday
C - Comp Day
(8) Date Requested
Select:
R - Regular Day Off
V - Vacation
AL - Administrative Leave
H - Holiday
C - Comp Day
Select:
R - Regular Day
V - Vacation
AL - Administrative Leave
H - Holiday
C - Comp Day
(9) Date Requested
Select:
R - Regular Day Off
V - Vacation
AL - Administrative Leave
H - Holiday
C - Comp Day
Select:
R - Regular Day
V - Vacation
AL - Administrative Leave
H - Holiday
C - Comp Day
(10) Date Requested
Select:
R - Regular Day Off
V - Vacation
AL - Administrative Leave
H - Holiday
C - Comp Day
Select:
R - Regular Day
V - Vacation
AL - Administrative Leave
H - Holiday
C - Comp Day
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. Thank you.