Time-Off Request Form
• Time-Off requests must be submitted 7 days in advance.
• Finding coverage for you shift will improve the likelihood of approval
• Time off requests may be approved / denied at the manager’s discretion. Approval / denial will be based on prior requests from yourself and other employees and available coverage

• Black Out dates are Memorial Day Weekend, July 4th, and Labor Day Weekend. We will not be accepting time off requests for these days.

Name *
Your answer
Employee Pin *
0 + last 4 digits of your social
Your answer
First day you are requesting off *
MM
/
DD
/
YYYY
Last day you are requesting off *
MM
/
DD
/
YYYY
Which location are you scheduled to work at? *
Your answer
Have you found coverage? *
Approval may be contingent upon finding coverage
If so, who is covering your shift?
Your answer
Reason for requesting time off *
Your answer
Electronic submission of this document will act in lieu of a signature and employee statement that all above information is correct
Submit
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