Request Day Form
 
Benefit Requested:
 
Facility:
Team Member Name:
 
Department:
Date of Hire:

 (mm/dd/yy)
 
 

Employee File Number :  (see paycheck stub)
 
SSN:
 
 
Date Requesting
Paid On:		  (mm/dd/yy)
 
 
Day(s) Off/
Paid Requested:		  (mm/dd/yy)
 
 
     TO  
 (mm/dd/yy)
 
 
Number of Days/
Hours Requested:
 
Other Comments
Email Address to Receive
Confirmation of Request
 

Vacations: Full-Time and Part-Time team members are entitled to vacation on a pro-rated basis, based upon the number of hours worked within a year. The amount of pay will be calculated by taking the total hours for that year and dividing by fifty (50) to obtain an average week's pay. Yearly continuous employment is necessary to receive vacation pay for part-time or full-time team members. Team members may not accumulate vacation from year to year. All earned vacations are payable upon date of eligibility or can be issued on the first check upon return to work. Each team member must have the Administrator's approval in advance to take more than one week's vacation at a time if eligible.

Birthday: After successfully completing nine (9) months of continuous full-time employment, full-time team members will be given their birthday off with pay. It is your responsibility to notify your supervisor and complete the necessary request form. While we will make every attempt to schedule your birthday off, alternative dates may be necessary.

Health Pay: Any full-time team member that works 30 days with no call offs, lates, and/or tardies will receive 1/2 days pay. Any full-time team member going three (3) consecutive months with no call offs, lates, or tardies will receive an additional 1 day of pay. The maximum number of days team members can earn off per year is ten (10) days. Earned days off do not accumulated from year to year, corresponding pay for days earned does.

The front office maintains records of the number of days earned/allowed for vacation, birthday, and health pay.


Back to top