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Staff – Emp Request Forms
Employee Request Forms
Paid / Unpaid Time Off Request Form
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Date
YYYY dot MM dot DD
Name
(Required)
First
Last
Email
(Required)
Phone
(Required)
Note: Please Request all times within 1 week (Sunday to Saturday). Please submit any other weeks on seperate forms.
(Required)
I understand.
IF "Amount PTO" field is left blank , accrued time will NOT be used. If the request is under 2 weeks, PTO MAY NOT be approved. Explanation below required if less than 2 weeks. If more than a week submitted, PTO may not be credited on payroll and you may be asked to resubmit.
Sunday - Date
MM slash DD slash YYYY
Amount PTO - Sunday
Please enter a number less than or equal to
8
.
Monday - Date
MM slash DD slash YYYY
Amount PTO - Monday
Please enter a number less than or equal to
8
.
Tuesday - Date
MM slash DD slash YYYY
Amount PTO - Tuesday
Please enter a number less than or equal to
8
.
Wednesday - Date
MM slash DD slash YYYY
Amount PTO - Wednesday
Please enter a number less than or equal to
8
.
Thursday - Date
MM slash DD slash YYYY
Amount PTO - Thursday
Please enter a number less than or equal to
8
.
Friday - Date
MM slash DD slash YYYY
Amount PTO - Friday
Please enter a number less than or equal to
8
.
Saturday - Date
MM slash DD slash YYYY
Amount PTO - Saturday
Please enter a number less than or equal to
8
.
This field is hidden when viewing the form
Total Hours Requested
I acknowledge that "IF" this Schedule Request is less than 2 weeks notice, my PTO may be denied "AND" I will call the office immediately after submitting. (Short Notices need to be reported to Office Administration for Scheduling Purposes)
(Required)
I understand and will call 859-303-4040 after submitting if less than 2 week notice.
Call immediately - If after hours, call and press 0 to speak with the on call manager. Leave Voicemail if not answered.
Explanation if needed
Why needed and why if less than 2 weeks.
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Weekly Availability Change Form
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Date
YYYY dot MM dot DD
Name
First
Last
Date the change should start
MM slash DD slash YYYY
Schedule change requests must be made 2 weeks in advance
I have made this request 2 weeks in advance
In the fields below, please enter your requested availability in the following format: 8a-5p, 12p-6p
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Add
Remove
Email
Notes
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This field is hidden when viewing the form
I want all the info
Select All
Choose 1
Choose 2
Name
This field is for validation purposes and should be left unchanged.
PPE - Personal Protective Equipment - Form
Name
(Required)
First
Last
Email
Select All That Apply
Small Gloves
Medium
Large Gloves
Disposable Masks
Reusable Cloth Masks
Isopropyl Alcohol
Hand Sanitizer
Shoe Covers
Face Shields
Protective Suit
Write in Request(s)
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