Time Off Forms | Goodmanson Construction

Time Off Request Form

Please use a separate time off request form for each week that you are requesting time off.

Name(Required)

First Last

Today's Date(Required)

MM slash DD slash YYYY

Amount of Paid Time Off days accrued...

Amount of Unpaid Time Off days available...

I'm requesting:(Required)

Paid Time Off

Vacation (request also applies to snow)

Unpaid Time Off

Personal

No Out of Town Travel

Start Date of Requested Off(Required)

MM slash DD slash YYYY

End Date of Request Time Off(Required)

MM slash DD slash YYYY

Are You Available By Phone?(Required)

Yes

Number to be Reached At:

Reason for Request and / or Additional Remarks(Required)

Leave of Absence Form

You must submit requests for absences, other than sick leave, at least 2 days prior to the first day you will be absent.

Name(Required)

First Last

Today's Date(Required)

MM slash DD slash YYYY

Type of Leave Requested:(Required)

Sick

Military

Maternity/Paternity

Bereavement

Jury Duty

Time Off With Pay

Time Off Without Pay

Start Date of Absence(Required)

MM slash DD slash YYYY

End Date of Absence(Required)

MM slash DD slash YYYY

Reason for Absence:(Required)

Will You Be Available By Phone?(Required)

Yes

Phone Number To Be Reached At:

Will You Be Available for Company Calls?(Required)

Yes

Will You Be Available for Customer Calls?(Required)

Yes

Employee FMLA Request Form

Notice of Eligibility & Rights and Responsibilities under the Family and Medical Leave Act

In general, to be eligible to take leave under the Family and Medical Leave Act (FMLA), an employee must have worked for an employer for at least 12 months, meet the hours of service requirement in the 12 months preceding the leave, and work at a site with at least 50 employees within 75 miles. While use of this form is optional, a fully completed Form WH- 381 provides employees with the information required by 29 C.F.R. §§ 825.300(b), (c) which must be provided within five business days of the employee notifying the employer of the need for FMLA leave. Information about the FMLA may be found on the WHD website at www.dol.gov/agencies/whd/fmla.

Today's Date(Required)

MM slash DD slash YYYY

Employer(Required)

Employee(Required)

First Last

Date Request Submitted(Required)

MM slash DD slash YYYY

Date Leave Begins(Required)

MM slash DD slash YYYY

Date Leave Ends (Optional)

MM slash DD slash YYYY

Reason(Required)

The birth of a child, or placement of a child with you for adoption or foster care, and to bond with the newborn or newly-placed child

Your own serious health condition

You are needed to care for your family member due to a serious health condition. Your family member is your:

Spouse

Parent

Child under age 18

Child 18 years or older and incapable of self- care because of a mental or physical disability

A qualifying exigency arising out of the fact that your family member is on covered active duty or has been notified of an impending call or order to covered active duty status. Your family member on covered active duty is your:

Spouse

Parent

Child of any age

You are needed to care for your family member who is a covered servicemember with a serious injury or illness. You are the servicemember’s:

Spouse

Parent

Child

Next of Kin

Definitions

Spouse means a husband or wife as defined or recognized in the state where the individual was married, including in a common law marriage or same-sex marriage. The terms “child” and “parent” include in loco parentis relationships in which a person assumes the obligations of a parent to a child. An employee may take FMLA leave to care for an individual who assumed the obligations of a parent to the employee when the employee was a child. An employee may also take FMLA leave to care for a child for whom the employee has assumed the obligations of a parent. No legal or biological relationship is necessary.

Issues or Questions?

If you have any issues with completing these forms, or have questions related to taking time off, please contact Molly.