Sample Vacation Request Form
Please submit this form for approval at least four weeks in advance of your preferred vacation dates.
Date: _____________
Employee Name: ___________________________________
Title: _________________________
Department: ___________________
Vacation Days Earned: _____________
Vacation Dates Requested: ____/____/______ through ____/____/______
Returning: ____/____/______
Total Number of Days Requested: _____________
__________________________________ Date____________
Signature of Employee
Approval:
__________________________________ Date____________
Manager
Employer Note: Please be sure to clearly communicate your company’s policy regarding accrued vacation
days to your employees.
