EmailMeForm
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.
Name:
*
First
Last
Telephone:
*
###
-
###
-
####
Pleases list your personal email:
*
Location currently working at:
*
Bloomington
Admin
Bossen 1
Bossen 2
Carriage Oaks
5th Ave
Chicago
Christian Park
Crosstown
Dupont
Fremont
Jurdy
Lakeland
Minneapolis
Oliver
Pillsbury
Pleasant
Queen
Running Park
Sander 1
Sander 2
Sander 3
Washburn
Lead Name for the location you are at:
*
Shift Time
Example: 3p-11p, 5p-11p, 8:30a-11p
Start Date of Requested off
MM
/
DD
/
YYYY
End Date of Requesed off
MM
/
DD
/
YYYY
Additional Notes