Time-off Request Form
Personal, sick, vacation, or other time when you are not performing duties for SSCS. (NOT for Professional Development and Field Trip requests.)
Email
*
example@example.com
Select your immediate Supervisor:
*
Please Select
DiPace, Tony
Gray, Chris
Osterberg, Glen
Simpson, Melissa
Yorke, Tom
Name
*
First Name
Last Name
Start Date
*
-
Month
-
Day
Year
Date Picker Icon
Hour : Minute
AM
PM
AM/PM Option
End Date
*
-
Month
-
Day
Year
Date Picker Icon
Hour : Minute
AM
PM
AM/PM Option
Reason for request
*
Personal Business
Sick/Medical
Vacation
Other (explain)
Will you need a substitute?
*
Yes
No
Please explain any unusual situations, reason for request, or substitute preferences.
*
*Every effort will be made to accomodate specific requests, but nothing is guaranteed.
Upload any relevant information.
Browse Files
Drag and drop files here
Choose a file
(ex. Doctor's notes, etc.)
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of
Personal Business is any activity that cannot be completed outside of regular work hours. By selecting this option, you attest to the fact that the time away from SSCS will be spent taking care of Personal Business that could not otherwise be tended to outside of your normal workday and that - to the best of your knowledge - you have enough personal time available to cover the request.
*
Yes
No
Sick/Medical leave is reserved for pre-scheduled medical appointments or medically relevant leaves of absence for the employee or an immediate family member. By selecting this option, you attest to the fact that the time away from SSCS will be spent at a pre-scheduled medical appointment or for medically relevant leaves of absence for yourself or an immediate family member and that - to the best of your knowledge - you have enough sick time available to cover the request.
*
Yes
No
Vacation time is available per contract. By selecting this option, you attest to the fact that - to the best of your knowledge - you have enough vacation time available to cover the request.
*
Yes
No
By selecting this option, you attest to the fact that - to the best of your knowledge - you are eligible to take the time needed to cover the request.
*
Yes
No
Submit For Approval
Should be Empty: