Name/Primer Nombre y Apellido

First Name

Last Name

Email/Correo Electronico

Employee Number/Numero de Empleado

Total Days Requesting Off/Total de días de solicitud

Date (s) Requesting Off From - Through/Fecha(s) Solicitud de salida desde - hasta

Ex. 1/1/22-1/3/22 (Please keep in mind the work week is Monday-Friday if you request days on different weeks please submit more than one request)

Type of Time Off/Tipo de tiempo libre

Please be aware that if you do not have the time indicated above available, you will not be paid. Time off balances can be found on your paycheck stub or on the Paychex Flex app.

Sick

Vacation

COVID

Business

Have you notified your manager?/¿Ha notificado a su gerente?

Yes

Additional Comments/Comentarios adicionales

Type Name to Approve Request/Escriba el nombre para aprobar la solicitud

First and Last Name

Last 4 of Social Security #/Últimos 4 de la Seguridad Social #