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Vacation/Time Off Request Form
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Employee Information

Name:
Email:
Department:
Manager:


Details of Absence

Number of (working ) days requested:

Date From:
Date To:


Reason for Absence

Vacation Current Entitlement including carry over (days)
Outstanding Entitlement (days)

Time off in lieu. Please provide details:


Bereavement. Please provide details:


Other Please provide details:


Approval

Approved by:
Date: