Vacation Request Form

Name
First Last
Number business days entitled to:

Based on the HPBC policy, I am entitled to ________ business days of vacation. Vacation benefits are outlined in the HPBC Policy Manual. Vacation days will be allocated at the beginning of the calendar year upon completion of one full year of service.
Vacation Days Desired:
Dates Number of Business Days
Total Days
Number days used: Number days remaining:
Signatures
*
Employee Date
Executive Director Date

Vacation Days Desired: