Time Off Request

Time Off Request Form

Please complete this form to request time off. If the time off request is approved, you will be notified by the office.

"*" indicates required fields

Date request submitted*

First Name*

Last Name*

Email*

Cell Phone Number*

Type of Time Away*

Type of Time Away Other

Please explain "other"

Start/end times for partial days

Total hours requested*

Department/location*

Who will cover the workload/responsibilities while you are away?*

Additional Comments

Acknowledgment*

I understand that submitting a request does not mean it is approved.

5681 Transit Road
Clarence, NY 14051
716-832-1550

36 Columbia Avenue
Depew, NY 14043
716-832-1550

13 Hopkins Road
Williamsville, NY 14221
716-832-1550

2047 Baseline Road
Grand Island, NY 14072
716-832-1550