EmailMeForm
Loving Care Home Care Vacation/Time Off Request
REQUESTING TIME OFF LESS THAN 14 DAYS IS IS AUTOMATIC TERMINATION.
All Vacation/Time off must be submitted at least 14 days in advance. Vacation/Time Off request are not approved unless a Manager confirms this request in writing. Submitting a vacation/time off request does not guarantee vacation/time off.
You will need to submit more than one request for multiple vacation/time off request.
Employee Name
*
First
Last
Your Phone Number
*
###
-
###
-
####
Email
*
Vacation Dates Requested
*
MM
/
DD
/
YYYY
Enter the first date of your requested vacation/time off
Through
*
MM
/
DD
/
YYYY
Enter the last date of your requested vacation/time off
Returning:
*
MM
/
DD
/
YYYY
Enter the day you plan to return to work
Total Number of Hours Requested Off
*
Enter the Name of your Client that will not receive services during your vacation/time off.
You will need to list the time of day you service the client and the day of the week you service the client and the number of hours for each day:
*
Enter the Name of your Client that will not receive services during your vacation/time off.
You will need to list the time of day you service the client and the day of the week you service the client and the number of hours for each day:
Enter the Name of your Client that will not receive services during your vacation/time off.
You will need to list the time of day you service the client and the day of the week you service the client and the number of hours for each day:
Enter the Name of your Client that will not receive services during your vacation/time off.
You will need to list the time of day you service the client and the day of the week you service the client and the number of hours for each day: