Time off request form
A one-page time off request with dates, type of leave, backup contact and manager sign-off boxes.
- ๐บ๐ธ US format ยท Letter size
- Free
This is a sample form. Check that the terms and pay match federal and state labor rules and your company policy.
Fill in what you need. The preview updates as you type.
What you type is not saved on our server.
Your company policy comes first
Time off, leave and travel approvals follow your employee handbook and your state's rules. If your employer has its own form, use that one. This template is a quick way to draft the same information and is not legal advice.
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Time Off Request
| Manager | Human Resources |
| Employee | Jordan Lee | Department | Marketing, Associate |
|---|---|---|---|
| Employee ID | EMP-0231 | Date | October 5, 2026 |
| Type of leave | โ Vacation / PTOย ย โก Half dayย ย โก Personalย ย โก Bereavementย ย โก Unpaid | ||
| Dates | October 16, 2026 to October 20, 2026 (3 days, weekdays only) | ||
| Reason | Family trip. Tickets are booked and the Q4 campaign brief is already with the team. | ||
| Backup contact | Sam Park, Marketing | Contact while away | (555) 010-0000 |
I request the time off described above and confirm my work is covered. October 5, 2026 Employee signature: Jordan Lee To: Human Resources | |||
How to use it
Pick the type of leave and the dates, and the form counts the days for you. Weekends are skipped by default. Half days use one date and count as 0.5. Add the name of whoever is covering your work and how to reach you if something cannot wait.
The sign-off boxes at the top right are for your manager and HR. Change the labels to match your company's approval chain, or set them to None if approvals happen in a system.
Things to watch
Submit the request as early as your handbook asks, often two weeks for vacation. The form does not check your PTO balance, so look it up first. If your employer has its own request form, use that one and copy this information into it.
Calculators that go with this
Frequently asked questions
Does this count public holidays?
No. It counts calendar days, or weekdays when the weekday option is on. If a holiday falls in the range, note it in the reason box so the day count is clear.
Can I use it for FMLA or medical leave?
For a long leave, use the leave of absence request. FMLA has its own federal forms (WH-380) that your employer will give you.
How many sign-off boxes do I need?
Match your company's approval chain. A small team often uses one box for the manager. Larger companies add Reviewed by and Approved by. Pick None if approvals happen by email and you only need the body of the form.
Is what I type saved anywhere?
No. Everything stays in your browser and nothing is sent to our server. If you refresh the page it is gone, so print, save a PDF or download the DOCX when you are done.