Employee Hours/Shift-Related Request Form
Date
04
/
23
/
2025
This form is a request for:
Time off work
A shift-change
I understand that this is only a request until approved by my manager.
Employee Name:
My job role is:
Please select
CSR
Vet Assist
Vet Tech
Surgical Vet Tech
Expediter
Marketing Manager
Team Lead
Hospital Manager
Please select
Employee email:
My primary hospital location is:
Please select
39th Ave/Holistic
Main St
Newberry
Springhill
Please select
I would like to take the following date/shift/hours off work:
I am requesting to have my shift on:
MM
/
DD
/
YYYY
...covered by the following employee:
I will be working for THEM on the following date
(Only fill this portion out if you are covering a shift for THEM):
MM
/
DD
/
YYYY
If you are not working a shift for them, LEAVE THIS BLANK!
Email of that employee for a copy of this request:
Additional comments:
Signature
Clear
Employee Signature for request confirmation
REQUEST NOW
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