Staff Employee Request Forms Time Off Request Form Time Off Requests Name* First Last Email PhoneDate(s) Requested* Month Day Year Do you wish to enter additional dates? Yes Date Month Day Year Date Month Day Year Date Month Day Year Date Month Day Year Date Month Day Year Is The Date Requested Two Weeks In Advance?* Yes, it is two weeks in advance No, it is not two weeks in advance I acknowledge that this Schedule Request is not within the requested two weeks notice, my PTO may be denied, and I will call the office immediately after submitting.* I understand and will call 859-303-4040 after submitting. Call immediately - If after hours, call and press 0 to speak with the on call managerUse Accrued Hours (max 8 hr/day) Let us know if you want to use your accrued hours and how many. If field is left blank or not completed, accrued time will not be used. If the request is under 2 weeks, PTO MAY NOT be used.Explanation Availability Request Form Availability Request 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-6pSundayMondayTuesdayWednesdayThursdayFridaySaturday Add RemoveEmail PPE Request Form PPE Request Name First Last 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)