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Time Off Request Form

Time Off Request Form

EMPLOYMENT/JOB APPLICATION FORM [Include Mention Employers Information]

POSITION APPLIED FOR: [Position]

EMPLOYER'S INFORMATION Name: [City], [Who Employer],Address:

APPLICANT'S INFORMATION [State] Phone: [Phone number]

Name: [Employer's name]

Address: [Address], [Email]

POSITION INFORMATION [Phone number]

Are you eligible to work in the United States? [Name], [Applicant's name]

Yes [ZIP Code]

Available start date [State]

Desired employment [Start date] Preferred work arrangement: [Applicants Preferred Work Arrangement]

Full-time [Social security number]

Ability to work [Driver's license number]

At the office [Email]

Limitations [Include Applicant Eligible Work In]

EDUCATION/QUALIFICATIONS [Limitations]

High school: [Salary/rate];

Year of graduation: [ZIP Code], [Address].

Additional education [Desired Employment]

Awards, honors, notable achievements [Additional education]: [Achievements]. Skills: [Skills]. Certifications: [field18_0]. References: [field26_0].

ADDITIONAL INFORMATION [Name] Extra information: [Extra information]

Are you 18 years old? [Graduation year]

Yes [Include Applicant Any Certifications Or]

Are you a veteran? [Include Applicant Additional Education]

Yes [Include Applicant Any Awards Honors]

Do you need to relocate for this position? [Many Recent Jobs Mention]

Yes [Include Applicant Any Professional References]

Have you ever been convicted of a felony? [Include Applicant18 Years Old]

No [City]

AUTHORIZATION AND CERTIFICATION

I certify that all information provided in this application is accurate and complete to the best of my knowledge. I understand that any false statements or omissions may disqualify me from employment or result in dismissal if discovered after hiring.

I consent to the processing of my personal data and declare my agreement for the prospective Employer to collect, process, and use such information during the application and/or hiring process. I agree that my personal data may be transferred to third parties in connection with the application and/or hiring process and may be collected for reporting purposes. The prospective Employer shall collect, use, store, and protect my personal data in accordance with federal, state, and local laws and regulations.

Applicant's signature: ____________________

Date:[Date of signing]

Party 1

________________

Signature

Date: ________________

Party 2

________________

Signature

Date: ________________

Maintained by Vladislav Sergienko, Founder·Template last modified: ·Report an error

What Is a Time Off Request Form?

A Time Off Request Form in the United States puts a formal request before the recipient and sets out the grounds supporting it.

While no federal law mandates paid vacation time, employers who offer paid time off must administer it consistently under their stated policies to avoid claims of discrimination or retaliation. The Family and Medical Leave Act (FMLA), 29 U.S.C. Section 2601 et seq., requires covered employers (those with 50 or more employees) to provide eligible employees up to 12 weeks of unpaid, job-protected leave for qualifying reasons including serious health conditions, care for a family member, and bonding with a new child. FMLA regulations under 29 CFR Part 825 require employers to maintain records of leave requests and approvals for at least three years.

Many states and municipalities have enacted additional leave laws that exceed FMLA protections. California's Paid Family Leave program, New York's Paid Family Leave law, and paid sick leave ordinances in cities including San Francisco, Seattle, and Chicago all impose specific documentation requirements that make standardized time off request forms essential for compliance. A properly designed form helps employers track leave balances, confirm equitable treatment across departments, and maintain the documentation needed to defend against leave-related disputes.

When Do You Need a Time Off Request Form?

A time off request form is needed whenever an employee plans to be absent from work for any reason covered by the employer's leave policy. Vacation requests should be submitted according to the advance notice period specified in the employee handbook, typically two to four weeks before the requested dates, to allow for scheduling coverage and workload redistribution. Employees requesting extended leave for planned medical procedures, family caregiving, or personal sabbaticals need to submit formal requests that trigger the employer's obligations under FMLA or applicable state leave laws.

Sick leave requests, while often submitted after the fact for unplanned illness, still require documented forms to track usage against available balances and to identify patterns that may indicate leave abuse or the need for reasonable accommodations under the ADA. Bereavement leave requests should reference the employer's bereavement policy and specify the relationship to the deceased, as most policies provide different amounts of leave depending on the closeness of the relationship.

Jury duty and court appearance requests require documentation because employers in most states are prohibited from retaliating against employees who serve on juries under statutes like the Jury Systems Improvement Act (28 U.S.C. Section 1875). Military leave requests by National Guard and Reserve members are protected under the Uniformed Services Employment and Reemployment Rights Act (USERRA), 38 U.S.C. Section 4301 et seq., which requires employers to grant leave for military service and reemploy returning service members. Voting leave, domestic violence leave, and organ donor leave are additional categories protected by various state laws that require proper documentation.

What to Include in Your Time Off Request Form

A complete time off request form must include the employee's full name, employee ID or department, job title, supervisor name, and the submission date. The requested absence section should specify the start date, end date, total number of days or hours requested, and whether the absence covers full days or partial days with specific hours noted. Include a leave type classification that matches the categories in the employer's leave policy, such as vacation, personal day, sick leave, FMLA leave, bereavement, jury duty, military leave, or unpaid leave of absence.

The leave balance section should display the employee's current available balance for the requested leave type, calculated as of the request date. This prevents employees from requesting more time than they have accrued and creates a clear record if disputes arise about leave entitlements. For FMLA-qualifying requests, include a section for the employee to describe the qualifying reason (without requiring detailed medical information on the basic request form) and a notation that the employer will provide the required FMLA eligibility notice within five business days as mandated by 29 CFR Section 825.300.

The approval section should include spaces for the supervisor's signature, approval or denial decision, date of decision, and any comments or conditions. If the request is denied, established procedures require a stated reason to protect against claims of discrimination or retaliation. Include a field for noting coverage arrangements during the employee's absence and any deadlines for completing work before departure. The form should reference the employer's leave policy by name or handbook section number, and include a statement that misrepresentation of the reason for leave may result in disciplinary action up to and including termination. Retain completed forms in the employee's personnel file for the duration required by your state's record retention laws, with a minimum of three years recommended for FMLA compliance.

Sources & Citations

Statutory citations link to official government sources.

  1. ADAUS – Cornell LII
  2. Family and Medical Leave ActUS – Cornell LII
  3. FMLAUS – Cornell LII

Cite this page

Reference this free template in an article, syllabus, or research note:

APA

Forms Legal. (2026). Time Off Request Form (United States) [Legal document template]. Forms Legal. https://forms-legal.com/usa/employment/hr-forms/time-off-request-form

MLA

"Time Off Request Form (United States)." Forms Legal, 2026, https://forms-legal.com/usa/employment/hr-forms/time-off-request-form.

BibTeX
@misc{formslegal-time-off-request-form,
  author       = {{Forms Legal}},
  title        = {Time Off Request Form (United States)},
  year         = {2026},
  howpublished = {\url{https://forms-legal.com/usa/employment/hr-forms/time-off-request-form}},
  note         = {Free legal document template. Based on Family and Medical Leave Act (29 U.S.C. §2601)}
}

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Frequently Asked Questions

Based on Family and Medical Leave Act (29 U.S.C. §2601) — Template last modified June 2026Verify the source →

This template is provided for informational purposes only and does not constitute legal advice. Laws vary by jurisdiction and change over time. Consult a qualified attorney for advice specific to your situation.Full disclaimer

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