Time Off Submission Employee Time-Off Request Keep All Requests in the same week. If less than two week notice you must talk to management. Please call the office and if somebody does not answer, leave a voicemail and explanation. (859) 303-4040. Please submit each day for the hours you are scheduled for. Name(Required) First Last Email(Required) Leave Type(Required)Do Not Use PTOSickVacationReason / Notes (Optional)Sunday HoursPlease enter a number from 1.0 to 8.0.Sunday Date(Required) MM slash DD slash YYYY Monday HoursPlease enter a number from 1.0 to 8.0.Monday Date(Required) MM slash DD slash YYYY Tuesday HoursPlease enter a number from 1.0 to 8.0.Tuesday Date(Required) MM slash DD slash YYYY Wednesday HoursPlease enter a number from 1.0 to 8.Wednesday Date(Required) MM slash DD slash YYYY Thursday HoursPlease enter a number from 1.0 to 8.0.Thursday Date(Required) MM slash DD slash YYYY Friday HoursPlease enter a number from 1.0 to 8.0.Friday Date(Required) MM slash DD slash YYYY Saturday HoursPlease enter a number from 1.0 to 8.0.Saturday Date(Required) MM slash DD slash YYYY Total Hours RequestedConsent(Required) I agree to the Independence Assistance’s “Paid Time Off” policies.This field is hidden when viewing the formDate Submitted(Required) MM slash DD slash YYYY
