Leave Request Form
This form is for requests for leave during dates that have not yet been scheduled. If a shift you are requesting off appears on your calendar in eRsp, please refer to the Shift Change Agreement form.

Please understand that requests are approved on a first-come, first-served basis.

As such, we ask that you please wait to hear back from the scheduler before making reservations or purchasing tickets to travel or for an event, as on occasion we may not be able to accommodate that leave request, if multiple other employees have already been approved for leave during that time. Ordinarily, we expect to respond to leave requests within 3 business days.
Your Name *
Your answer
Date of start of leave *
MM
/
DD
/
YYYY
Time of start of leave *
Time
:
Date of end of leave *
MM
/
DD
/
YYYY
Time of end of leave *
Time
:
Customers with whom you are scheduled during specified dates of leave *
Your answer
Submit
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