Time off Notice Form

Please list all languages you interpret. You do not need to list English.
Please check every day you are typically scheduled.
Please select the first date you would like off
Please enter the last date you’d like off. If you are only taking one day, This date should should be the same as “First Date Out”
Paid time off will only be applied if you have any available in the current year. If you select “yes” but don’t have enough, only your available paid time will be applied.