Time Off Request Form - Hourly Employee
*As stated in the Staff Reliability Policy, Zumbro House requests a two week notice for time off. Requests should be submitted via this form, which will be automatically submitted to your Program Director who will then coordinate scheduling with the house Lead DSP. The earlier an employee requests off, the more likely the time off will be granted.
Time off may not be granted if several key employees request time off at the same time.
An employee requesting time off must find their own replacement for the shift(s) but the replacement must work only at that site. All schedule changes/switches must be approved by the Lead DSP or Program Director prior to that shift.
Your Lead DSP will let you know the status of your request.
Pleases list your personal email:
Location currently working at:
Lead Name for the location you are at:
Example: 3p-11p, 5p-11p, 8:30a-11p
Start Date of Requested off
End Date of Requesed off