[Firm Name]

PERSONAL TIME OFF REQUEST and APPROVAL

Dates Requested – please submit separate requests for multiple periods:

Available Time:

Comments:

Employee’s Signature _________________________________Date_________

Approval Signature(s)__________________________________Date_________

Instructions:  Complete section regarding available time, which should reflect anticipated accrual at period when time off is requested.  The comment section should include remarks as to how time sensitive responsibilities will be covered in your absence.  Obtain approval from your direct supervisor and the shareholder(s) or firm administrator you’re working with most closely before submitting to [Name].  Once you have obtained approval the process is complete unless you are advised to the contrary within 5 days due to scheduling conflicts.