Residential Services Inc.

Leave Request Form

Complete the form below to request time off from your regularly scheduled hours. Leave requests for ANNUAL leave should be submitted to the Personnel Department at least two weeks before the requested time off. Leave is not approved unless you receive a printed copy of this form indicating the approval from both the Personnel Department and the Supervisor of Support Services or Director. SICK leave requests must be submitted within 48 hours after the leave occurred. (Part-time employees do not receive paid time off. Part-time staff should simply indicate their status as such.)

 

Name: 

Email Address: 

Valid email address is required.  An email confirmation will be sent to the email address above for your records.  If you do not have an email address, please input the email address of your primary work location.

Please Select the location(s) from which you are requesting time off and the corresponding dates and times you are scheduled to work.  (begin with the location you are scheduled to work the most hours.  If you are a supervisor, please choose a location that you supervise.

1st Location:    Aberdeen Apartments Carrboro Christopher Clayton Ferrell Gary Hamilton Life Options Main Street Oleander Purefoy Quail Roost Community Vocational and Learning Services Shadylawn Silo Spring Glen Umstead Woodcrest Office Personnel Finance	Hours/ Date Scheduled:
2nd Location:   Aberdeen Apartments Carrboro Christopher Clayton Ferrell Gary Hamilton Life Options Main Street Oleander Purefoy Quail Roost Community Vocational and Learning Services Shadylawn Silo Spring Glen Umstead Woodcrest Office Personnel Finance	Hours/ Date Scheduled:
3rd Location:    Aberdeen Apartments Carrboro Christopher Clayton Ferrell Gary Hamilton Life Options Main Street Oleander Purefoy Quail Roost Community Vocational and Learning Services Shadylawn Silo Spring Glen Umstead Woodcrest Office Personnel Finance	Hours/ Date Scheduled:
4th Location:    Aberdeen Apartments Carrboro Christopher Clayton Ferrell Gary Hamilton Life Options Main Street Oleander Purefoy Quail Roost Community Vocational and Learning Services Shadylawn Silo Spring Glen Umstead Woodcrest Office Personnel Finance	Hours/ Date Scheduled:
5th Location:    Aberdeen Apartments Carrboro Christopher Clayton Ferrell Gary Hamilton Life Options Main Street Oleander Purefoy Quail Roost Community Vocational and Learning Services Shadylawn Silo Spring Glen Umstead Woodcrest Office Personnel Finance	Hours/ Date Scheduled:

Job Title:	Direct Support Professional Direct Support Coordinator Senior DSC Supervisor of Support Services Administrative Staff
Hire Date: (Month/Year)
Type of Leave Requested:	Full-Time Annual Leave Full-Time Sick Leave Part-Time
Total Hours Requested:
Full time employees only: indicate your current leave balance (sick or annual)

If you do not have sufficient paid time off to cover the amount of hours requested, you will need to submit a letter of request to your Department Director.

Other Comments:


After you hit the submit button you will see an on screen confirmation showing the information that you entered.  Please print or save the next screen for your reference.