Vacation Requests Vacation Requests Submit Vacation requests Employee Name Agency Name Vacation Dates Requested Total # of hours requested Requesting: PTO Unpaid Other Please check which of the following has been completed: DON / Administrator has approved Office staff is aware and has modified schedule I have given or will give "hand off" reports (both office and field staff) Reason for Request Appointment Vacation Funeral / Bereavement Jury Duty Family Reasons Medical Leave "Sign" and date
