It is recommended that based on your organization’s policies, that employees requesting time off to complete and submit this form to their supervisor/manager for approval/denial.
Once signed a copy should be given to the employee and a copy becomes part of the employee’s permanent human resource file.
* By clicking “download now,” permission of use is granted to the original purchaser ONLY and cannot be resold or distributed. This is an example policy and can be modified. It is recommended by United Physician Services that all the organization policies and procedures be readily available (real time) to all employees within the working facility. © United Physician Services, all rights reserved.