Time-Off Request

Menu

Today's Date

Employee Email

Employee Name

Reason for Request

Vacation Medical Leave Jury Duty Personal Leave Family Reason Sick Funeral/Bereavement To Vote Other

Is this request for days or hours off?

Days Hours

Is this request for paid or unpaid days or hours off?

Paid Unpaid

Which dates/hours would you like off?

Additional Notes:

I understand that his request is subject to approval by my employer.

Type in your initials to sign the form

Proudly serving Bastrop, Elgin, Smithville, LaGrange, Cedar Creek, Giddings, and other areas within a 60 mile radius of Bastrop County.

Get In Touch

Services

About