REQUEST FOR SCHEDULED TIME OFF

Use the below form to request Scheduled Time Off, i.e. foreseeable Paid Leave, Paid Sick Leave, or Unpaid Leave. Please submit this form at least 7 days prior to earliest requested time off shift date. A response to this request will be given within 3 business days

IMPORTANT: Please submit a separate Request Form for each affected Scheduled Shift

For Unscheduled Time Off, i.e. unforeseeable Paid Leave, Paid Sick Leave, or Unpaid Leave, please call 773-961-8498 as soon as possible. If leaving a v-mail, please also email info@ciadc.org

Name

First Name

Last Name

Requested Time Off Date

Each Shift must have a separate Request Form

MM

DD

YYYY

Requested Time Off Shift Start

Each Shift must have a separate Request Form

Hour

Minute

Second

Requested Time Off Shift End

Each Shift must have a separate Request Form

Hour

Minute

Second

Below are decriptions of Paid Leave, Paid Sick Leave, and Unpaid Leave. For more details, please refer to the CIADC Time Off Policy with the Button above

Paid Sick Leave

• Can be used to attend a doctor’s appointment, recover from illness, take care of a family member, address domestic violence situations, and public health emergencies • Minimum usage 2 hours • If more than 3 consecutive workdays of PSL is requested, please provide certification of authorized PSL use • Time off hours exceeding Paid Sick Leave balance hours will be treated as Paid Leave

Paid Leave

• Subject to approval • Can be used for any reason • Minimum usage must equal Class/OSA/DM shift hours (Instructors/Department Managers only) -or- 2 hours (all other Employees) • Time off hours exceeding Paid Leave balance hours will be treated as Unpaid Leave

Unpaid Leave

• Subject to approval • Can be used for any reason

Type of Leave Requested

See definitions above

Paid Sick Leave, as available

Paid Leave, as available. Subject to approval

Unpaid Leave. Subject to approval

Available Paid Sick Leave or Paid Leave Balance

If requesting Paid Sick Leave or Paid Leave. Available Balance can be found by logging into your Square Payroll account with Button above

Shift Coverage

Use Make-Up Week, If Available (Instructors - Class Shift Only)

Sub Needed

Other*

*If indicated OTHER please describe coverage

REQUEST FOR SCHEDULED TIME OFF

6433 N. RAVENSWOOD CHICAGO, IL 60626

SUPPORT CIADC

GIFT CERTIFICATES

Request Time Off

REQUEST FOR SCHEDULED TIME OFF

6433 N. RAVENSWOOD CHICAGO, IL 60626

SUPPORT CIADC

GIFT CERTIFICATES