Time Off Request Form

Please fill out the following form to request time off. This is for occasional days outside of your holiday entitlement. This information must be submitted prior to the timetable being sent out for the week you are requesting time off, otherwise you may be required to arrange your own cover.

Name

First Name

Last Name

Date Submitted

MM

DD

YYYY

First Day Off Requested

MM

DD

YYYY

Last Day Off Requested

Only fill this section if you are requesting multiple days off

MM

DD

YYYY

Reason

If other, please specify

Do you require a full day off?

If no, please specify the hours you are unable to work.

If you are unable to be granted the day off you have requested, is there an alternate date that would work for you?

Alternate First Day Off Requested

MM

DD

YYYY

Alternate Last Day Off Requested

Only fill this section if you are requesting multiple days off

MM

DD

YYYY

Declaration

I declare that the information provided is accurate to the best of my knowledge. I understand that submission of this form does not guarantee approval of the requested leave.

Time Off Request Form

Nevis Centre