MBHC Request Off - Online Submission
 Request(s) must be received in the office and date stamped by Millbrook, a minimum of TWO WEEKS prior to the first day requested off, or FOUR WEEKS if you are requesting more than 2 days off. Late requests will not be granted unless it is an extreme emergency. The timeliness of your request is determined by the date submitted, NOT when started.
 Please make every effort to limit vacation requests to ONCE EVERY THREE MONTHS as it is extremely disruptive to your client. If you are CONSTANTLY taking vacation days you will not have permanent clients and will be considered for fill in’s only.
Email address *
Today's Date: *
Employee Name: *
Date(s) Requested: *
Current schedule on the requested date(s): *
If approved, please indicate below how would you like to receive a signature approved copy, i.e. Email, Snail Mail, Other (specify). *
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