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<br /> <br /> <br /> <br /> <br />Date Submitted: ______________________________________________________________________ <br /> <br />Employee Name: _____________________________________________________________________ <br />Department: _________________________________________________________________________ <br />Manager or Supervisor: ________________________________________________________________ <br />Reason for Time Off Request: <br /> <br /> Medical Vacation Other ____________________________ <br /> <br />Dates Requested Off: <br /> <br /> ________________________________ <br /> <br /> _____________ <br />Employee Signature Date <br /> <br /> <br /> <br />Shift Substitute Employee Name: __________________________________________________________ <br /> <br /> <br /> <br /> Shift Substitute Employee Signature Date <br /> <br /> <br /> <br /> <br /> Approved Not Approved <br /> <br />Comments: <br /> <br /> <br /> <br />Manager Signature Date <br /> <br /> <br /> Human Resources Signature Date <br />Time Off Information: <br />*All Time Off Requests must be submitted a minimum of 3 weeks in advance to obtain approval <br />Time Off Request / <br />Shift Change Form <br />Manager Approval <br /> <br />Shift Switch <br /> <br />Docusign Envelope ID: 177AA06A-30B4-42FF-A85A-78B5A7C51DBE