Your Name:
Your email:
Date(s) and/or Shift(s) Requested:
Paid Time Off (PTO) requested (CSEA represented staff):
Have you secured coverage for the absence? YesNo
If you have not found coverage, please provide the names of who you have reached out to:
Enter names(s) and dates(s) of staff who will take your shift(s):
If swapping shifts, please provide the date and time of the shift you will work and the name of the staff person taking your shift:
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