Summer 2023 Time Off Request Form
Name
*
First
Last
Email
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.
You may also select 1 day before and 1 day after whichever holiday you have marked as your #1 choice.
My FIRST CHOICE Holiday is:
*
Memorial Day (Monday, May 29th)
Independence Day (Tuesday, July 4th)
Labor Day (Monday, September 4th)
I am not requesting any holidays off
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 28th
Tuesday, May 30th
I am not requesting any additional days off
Would you like the day BEFORE and/or AFTER Independence Day off? (choose day(s))
Monday, July 3rd
Wednesday, 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 3rd
Tuesday, September 5th
I am not requesting any additional days off
My SECOND CHOICE Holiday is:
Independence Day (Tuesday, July 4th)
Labor Day (Monday, September 4th)
I am not requesting any other holidays off
My THIRD CHOICE Holiday is:
Labor Day (Monday, September 4th)
I am not requesting any other holidays off
My THIRD CHOICE Holiday is:
Independence Day (Tuesday, July 4th)
I am not requesting any other holidays off
My SECOND CHOICE Holiday is:
Memorial Day (Monday, May 29th)
Labor Day (Monday, September 4th)
I am not requesting any other holidays off
My THIRD CHOICE Holiday is:
Labor Day (Monday, September 4th)
I am not requesting any other holidays off
My THIRD CHOICE Holiday is:
Memorial Day (Monday, May 29th)
I am not requesting any other holidays off
My SECOND CHOICE Holiday is:
Memorial Day (Monday, May 29th)
Independence Day (Tuesday, July 4th)
I am not requesting any other holidays off
My THIRD CHOICE Holiday is:
Memorial Day (Monday, May 29th)
I am not requesting any other holidays off
My THIRD CHOICE Holiday is:
Independence Day (Tuesday, July 4th)
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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