EMPLOYEE TIME-OFF REQUEST FORM

EMPLOYEE TIME-OFF REQUEST FORM
Today's Date:*

MonthDayYear
Date
Employee’s Name:*
Center
Email*
example@autismbehavioralhealth.org
If you only have one BCBA or two you can clear out the other line(s) on the form for BCBA email. It only requires one BCBA email to be submitted.
Your BCBA's Email 1 *
example@autismbehavioralhealth.org
Your BCBA's Email 2
example@autismbehavioralhealth.org
Your BCBA's Email 3
example@autismbehavioralhealth.org
BCBA Emails

Abby: Abigail@autismbehavioralhealth.org

Mikayla: MRamos@autismbehavioralhealth.org

Caitlin: CDussan@autismbehavioralhealth.org

Melissa: MGill@autismbehavioralhealth.org

Liz: EScinto@autismbehavioralhealth.org

Heather: HQuadrato@autismbehavioralhealth.org

Gail: GFelice@autismbehavioralhealth.org

Megan: mwestmoreland@autismbehavioralhealth.org

Anthony: ataylor@autismbehavioralhealth.org

Haley: hlamotta@autismbehavioralhealth.org

Amanda: Ahudick@autismbehavioralhealth.org

Cristie: Cpacete@autismbehavioralhealth.org

Rama: RMurugan@autismbehavioralhealth.org
Please list the date(s) requested off here. Start and end date if applicable. If it is only part of the day please also include that. Important: Each PTO request should cover a continuous range of dates. If you need time off on non-consecutive days (e.g., 11/14 and 11/26), you must submit a separate request for each date. *
PTO should be requested a minimum of 2 weeks in advanced.
Reason for Time Off:*
Accrued Paid Vacation TimePaid Sick Time (to be used for when you are sick, your child is sick, or a medical appointment)Paid Holiday Time / Floating Holiday (salaried employees)Not Applicable
Comments:
Employee’s Signature:*

Clear
Date Request is Submitted*

MonthDayYear
Date
Should be Empty: