Request Time Off

Remember that paid time off is for full-time employees only. All other requests are unpaid. Refer to policy #101

Complete this form to request time off work

All staff may use the from on this page to request days off. However, we will not approve requests for time off that are not submitted within the time frames stated in Agency Policies #101 and #108.

Full Name

Phone

Job Title

Do you understand that you WILL NOT be granted time off if you submit your request past the due date (last day of a month for time off in the 2nd month out)? Example: To request time off in September 2022, requests must be received at the office no later than July 31, 2022.

Start date of requested time off

End date of requested time off

Type of time off requested

Explanation

Are you requesting early approval?

989-497-7111
ext. 302

989-497-7111

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Request Time Off

Complete this form to request time off work

Tonya Bevins

Manny Garcia