Staff Time Request Form

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Please select from the options below for your Time Off or Overtime Request.

Note: If requesting Time Off using Banked Time or Vacation Days, please submit with at minumim two weeks notice.

Note 2: You do not require approval to use Sick Day(s) or Bereavement; provided you have enough accumulated.

Note 3: If requesting Overtime, please select each day you anticipate to work OT and enter roughly how many hours you think you will work past 4:30pm that day.

Month *

Month

Please choose which type of Request *

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Please choose which type of Request Vacation Day(s) Banked Hours Bereavement Overtime Unpaid Time Off

Vacation Date(s) Requested

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Total Vacation Day(s) Requested *

Banked Hours Requested

Please enter the hours you are requesting for each date

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0 hours

Total Banked Hours Requested *

Bereavement Day(s) Needed

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Total Bereavement Days Requested *

Overtime Hours Requested

Please enter the hour(s) you are requesting for each date.

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0 hours

Total Overtime Hours Requested *

Unpaid Day(s) Requested

Please enter the hours you are requesting for each date

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0 hours

Total Unpaid Day(s) Requested *

Additional Information / Comments

Provide any additional information relevant to this request, if necessary.

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