Paid Time Off Request Form
(Congregation Name)
Paid Time Off Request Form
Employee Name: ________________________________________________________
I would like to take time off work with pay.
I will be/was absent the following dates:
Please use: Personal Time (# of days ________)
Vacation Time (# of days _______)
Sick Time (# of days __________)
Whatever I Have Available
Other (circle one: continuing education, bereavement, jury duty, sabbatical)
I would like to take a Leave of Absence without pay on the following dates:
From: To:
(Employees requesting a leave of absence must have approval from the Pastor)
Employee Signature & Date Supervisor Signature & Date
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