Time off Notice Form Please enable JavaScript in your browser to complete this form.Your Name *FirstLastEmail *Language(s) You Interpret *Please list all languages you interpret. You do not need to list English. What Days are you Regularly Scheduled *MondayTuesdayWednesdayThursdayFridaySaturdaySundayPlease check every day you are typically scheduled. What Time Do Your Shifts Begin *What Time Do Your Shifts End *First Date Out *Please select the first date you would like offLast Date Out *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” Total Days Out *If you have Paid Time Off, Would You Like to Use any For This? *Yes, Please Use Paid Time OffNo, Time off Will be UnpaidN/A I do not have Paid Time OffPaid 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. How Many Hours of Paid Time Off Would you Like Used? *Whole hours only, partial hours such as 30 minutes, will be rounded to the full hour. If you put down more time off than you have available, only the available amount will be applied. Submit
