Summer Time Off Request Form
Name
*
First
Last
Phone
*
Email
Today's Date
*
MM slash DD slash YYYY
Please remember we have a high volume of requests for staff time off during the summer holidays. Planning is critical and
we will do our best to approve as many of these requests as possible.
Please select which Holiday is your FIRST PRIORITY from the list below: Memorial Day, July Fourth (Independence Day) or Labor Day.
My FIRST CHOICE Holiday is:
*
Memorial Day (Monday, May 27th)
Independence Day (Thursday, July 4th)
Labor Day (Monday, September 2nd)
I am not requesting any holidays off
You may also select 1 day before and 1 day after whichever holiday you have marked as your #1 choice.
Contact your ABC coordinator for any non-holiday time off you would like to request.
Would you like the day BEFORE and/or AFTER Memorial Day off? (choose day(s))
Sunday, May 26th
Tuesday, May 28th
I am not requesting any additional days off
You may also select 1 day before and 1 day after whichever holiday you have marked as your #1 choice.
Would you like the day BEFORE and/or AFTER Independence Day off? (choose day(s))
Wednesday, July 3rd
Friday, July 5th
I am not requesting any additional days off
Would you like the day BEFORE and/or AFTER Labor Day off? (choose day(s))
Sunday, September 1st
Tuesday, September 3rd
I am not requesting any additional days off
My SECOND CHOICE Holiday is:
*
Independence Day
Labor Day
I am not requesting any other holidays off
My THIRD CHOICE Holiday is:
Labor Day
I am not requesting any other holidays off
My THIRD CHOICE Holiday is:
Independence Day
I am not requesting any other holidays off
My SECOND CHOICE Holiday is:
*
Memorial Day
Labor Day
I am not requesting any other holidays off
My THIRD CHOICE Holiday is:
Labor Day
I am not requesting any other holidays off
My THIRD CHOICE Holiday is:
Memorial Day
I am not requesting any other holidays off
My SECOND CHOICE Holiday is:
*
Memorial Day
Independence Day
I am not requesting any other holidays off
My THIRD CHOICE Holiday is:
Memorial Day
I am not requesting any other holidays off
My THIRD CHOICE Holiday is:
Independence Day
I am not requesting any other holidays off
If you wish to be off on
MORE than ONE holiday
or additional days surrounding the holiday, you will be placed on a wait list. These request(s) may be approved as we get closer to the holiday, should your clients not need services, or we can find replacement coverage. Please do not make official plans until you are notified your request for holiday time off is “Approved”. We will continue to keep everyone updated about holiday time off. Thank you for your cooperation.
WANT TO WORK HOLIDAY?
If you want to work these holidays/or the days surrounding them, please let us know by May 1st.
This will help greatly in trying to meet staff requests for time off and our client’s needs. If you have any questions, please call a Client Care Coordinator.
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