This is a form that explains how employee vacation time is accrued. Employees earn
more vacation time after working with the company for a longer period of time. Newly
hired employees must wait one calendar year to use their earned vacation time. In
order to request vacation time, employees must submit their proposal to their supervisor
for approval. This form can be used by small businesses or other entities that want to
establish a consistent vacation policy for their employees.
Company Vacation Policy
Vacation Earning Schedule
Years of Eligible Service Vacation Days Each Year
(Upon initial eligibility)
After 1 year 5 days 5 days
After 2 years 10 days 10 days
After 3 years 10 days 10 days
After 4 years 10 days 10 days
The length of eligible service is calculated on the basis of a “benefit year.” This 12-month period
begins when the employee starts to earn vacation time.
However, before vacation time can be used, a waiting period of 365 calendar days must be
completed. After that time, employees can request use of earned vacation time, including that
accrued during the waiting period.
Paid Vacation time can be used in minimum increments of one day. To take vacation,
employees should request advance approval from their supervisors. Requests will be reviewed
based on a number of factors, including business needs and staffing requirements.
Vacation time off is paid at the employee’s base rate at the time of vacation. It does not include
overtime or any special forms of compensation such as incentives, commissions, bonuses, or
The vacation policy applies to all regular full-time employees. Earned vacation leave cannot be
taken before it is accrued and approved. Upon termination, unused earned vacation will be paid
in a lump sum in the employee’s final paycheck.
A maximum of (enter amount) paid vacation may be carried over from one calendar year to the
next. However, no more than one week of vacation may be taken at one time, except under
extraordinary circumstances. Requests for vacation should be made in writing at least ninety
 days prior to the beginning of the requested vacation period.
(The following paragraph is optional depending on the nature of your business.)
[The Widget Company] will offer employees the option of taking the dollar equivalent of their
earned vacation hours at their regular hourly rate. Arrangements to take earned vacation pay
should be made at least (1) one payroll period in advance.]
© Copyright 2011 Docstoc Inc. registered document proprietary, copy not 3
I have read and understood company’s vacation policy,
© Copyright 2011 Docstoc Inc. registered document proprietary, copy not 4
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