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info@companioncares.com

Mon - Fri 8.30 - 5.00
Saturday - Sunday CLOSED

 

Time Off Request

This form must be completed and submitted to your Supervisor at least 2 weeks prior to your requested time-off start date. If submitted any later, it is not likely to be approved by CHH Management.

First Name: Last Name: Supervisor Name:

Your e-mail:

Time Off Start Date:
Return to Work Date:

Total Time Off

Please check only 1 of the boxes and fill in the total shifts and/or hours that you will be taking off.

How much time do you need off?

How many hours?
How many days?

Days and Hours Off

Please list the dates, days, and times that you would like to take off.

Date:

Day:

(example: Monday)

Time Off Start

(check AM or PM)

Time Off End

(check AM or PM)

Type of Leave

Please check leave type.

Reason for Leave:

Employee Signature: (Please sign form below)