* = Required Information
Time Off Request Form - Hourly Employee
* As stated in the Staff Reliability Policy, A Helping Hand Senior Care Services LLC requests a two week notice for time off. Request should be submitted via this form, which will be automatically submitted to your Program Director when will then coordinate scheduling with the house Lead Counselor. The earlier an employee request off, the more likely the time off will be granted.
Time off may not be granted if several key employees request time off at the same time.
If an employee is not able to ask for the time off two weeks in advance, they have the option of finding their own replacement for the shift(s) but the replacement must work only at that site. All schedule changes/switches must be approved by the Lead Counselor or Program Director prior to that shift.
Your Lead Counselor will let you know the the status of your request.
First Name:
*
Last Name:
*
Telephone:
*
Please list your personal Email:
*
Location current working at:
*
3223 14th Ave. S
2446 15th Ave. S
2527 14th Ave. S
778 Blair Ave.
Lead Name for the location you are at:
*
Shift Time:
*
3:00pm - 11:00pm
5:00pm - 11:00pm
8:30am - 11:00pm
Start Date of Requested off
*
End Date of Requested off
*
Addtional notes
Submit