Time OFF

Request

Time Off Requests

Employee Name(Required)

First Last

Employee Gmail(Required)

Enter Email Confirm Email

Please use your Change, Inc. Gmail (NOT your @changeincorporated.org address)

Staff or Clinician?(Required)

Today's Date (Date of Request)(Required)

Is this request at least 6 weeks in advance?(Required)

Time away from work must be submitted in 6 weeks in advance wherever possible, except in the case of emergencies or incidental requests which could not be avoided. Please indicate the emergency or incident which prevented you from providing 6-weeks notice.(Required)

Time Off Beginning Date(Required)

Time Off Ending Date(Same Day if Only Requesting 1-Day Off)(Required)

Amount of Time Off Requested(Required)

Specify Amount of Time Off Requested(Required)

Please enter a number from 11 to 20.

Number of Client Days Off Requested(Required)

Please enter a number from 0.5 to 8.

Are you using paid time off or unpaid time off?(Required)

Please enter the date(s) you will be using as Make-Up Days. (NOTE: The eligible time frame for make-up days is the same Sunday to Saturday in which your intended time off takes place. For example, if you normally work MWF and take off a Friday, your make-up day should occur the preceding Sunday, Tuesday, Thursday, or Saturday of the same week.)(Required)