Apply for v Time Off Request -Internal Use Only

Summary
Title:	v Time Off Request -Internal Use Only
ID:	1014
Department:	Human Resources
Contact Information
* First Name:
* Middle Name:
* Last Name:
* Address 1:
Address 2:
* City:
* State:
* Zip:
* Phone:
* Email:

COMPLETING A TIME OFF REQUEST FOR AN UNPLANNED ABSENCE DOES NOT EXEMPT EMPLOYEES FROM CALLING IN TO HUMAN RESOURCE. YOU MUST CALL HR. EMAIL ISN'T ACCEPTED FOR CALLING IN.
• Unplanned Absence Definition: You didn't complete the online request 24 business hours before you will be off. HR must have time to be aware of the absence, and doesn't get emails away from work.
• Excuses are subject to verification of authenticity & must be turned in on the day of return.
• Please refer to your Employee Handbook for Vacation, Paid Sick Time & Non-Paid Time Off eligibility & rules.
• Employees are responsible for completing this form as soon as they know they will need to be absent from work for 15 minutes or more from their regular scheduled work week.

* First day you will miss time or be absent:

To Date: (Last day of your absence.) (Leave this blank only if you're absent 8 hours or less.)

Time I will arrive if coming in late:

Time I will leave if leaving early:

Will you return the same day for a partial day absence when leaving early?

No Yes

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* Type of Hours you want to use:

	Non-Paid Unexcused Time
	VACATION REQUEST: Can't be used the day before or after a Holiday unless request is completed 2 weeks prior to the Holiday.
	SICK TIME REQUEST: Must have worked 1 full year to receive Paid Sick Time. It will show on pay stub if you have it. Can't be used on Friday, Monday, the day before or after a Holiday without a doctor excuse.
	Salaried/Exempt employees only. Paid Excused Time (2 Hours or less )
	EXCUSED NON-PAID TIME : 2 full to 20 consecutive calendar days with valid excuse from a licensed Physician or court appearance in which your are on jury duty or a witness and NOT a party to a crime. Supporting documents must be turned in to HR when your absence begins to say you need to be out and the day of your return to work to verify you were out for the reason stated.
	FUNERAL LEAVE: YOU MUST COMPLETE SECTION NEAR BOTTOM

* Number of Hours to use: (Vacation and Sick Time MUST be 2 hour increments.)

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IF YOU WANT TO SPLIT THE MISSED TIME, please add what you want to use in addition to above:

	VACATION REQUEST: Can't be used the day before or after a Holiday unless request is completed 2 weeks prior to the Holiday.
	SICK TIME REQUEST: Must have worked 1 full year to receive Paid Sick Time. It will show on your paystub if you have it. Can't be used on Friday, Monday, the day before or after a Holiday without a doctor Excuse.

* Number of Hours to use: (Vacation and Sick Time MUST be 2 hour increments. ENTER 0 IF YOU AREN'T SPLITTING IT.)

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*FUNERAL LEAVE · Supporting documents must be turned in to HR BEFORE payroll is started at 8 am Monday mornings.

	1 Day Unpaid for Extended Family Member: employee’s aunts, uncles, first (1st) cousins, nieces and nephews.
	3 Days Paid for Immediate Family Member: Spouse, partner, children, parents, parents-in-law, siblings, grandparents, grandchildren, legal step and half-blood relatives.)

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• By signing below, I am stating I have verified from my most recent pay stub I have the Paid Time Off available I am requesting or either I am requesting Unpaid Time Off.
• Please type your First and Last name as an electronic signature to acknowledge that this request is only intended for current employees and you confirm that are the employee and you completed this form by yourself.

AFTER YOU HAVE CLICKED SUBMIT, DO NOT REFRESH THE SCREEN OR IT WILL SUBMIT THE APPLICATION AGAIN.
(On most mobile devices, the screen refreshes and submits again by pulling the screen down.)

I agree that this form may be electronically signed and agree that my typed signature is the same as a handwritten signature for the purposes of validity, enforceability, and admissibility.