Eastern ESS Time Off Request Form

Eastern ESS Time Off Request Form
Program *
Name *

First Name Last Name
E-mail *
Dates Requested *
Total Number of PAID Hours Requested *
Total Number of UNPAID Hours Requested *
Please include any specific notes/comments in the blank below.
** Please Note that a "full work day" is 8 hours (hours may be taken in 1hr increments)

** This form is NOT to be used for Personal Leave, Medical Leave, Maternity Leave or Military Leave (those requests must be made directly by the staff member to the HR Department)

All time off requests need to be made by the 18th of each month for consideration in the following month(s), unless staff member wants to apply available PTO for an excused absence where no notice was given.
Signature *

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