Time-Off Request Form

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• 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 *

Employee Pin *

0 + last 4 digits of your social

First day you are requesting off *

YYYY

Last day you are requesting off *

YYYY

Which location are you scheduled to work at? *

Have you found coverage? *

Approval may be contingent upon finding coverage

Yes

If so, who is covering your shift?

Reason for requesting time off *

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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