Before submitting this form, please remember:
- Requests for longer than 7 days must be submitted in the form of a typed, signed request letter to the physician in charge of scheduling.
- Requests must be submitted 45 days prior to the start of the schedule month (i.e. requests for June must be submitted by April 15th) to receive consideration.
- If a request is not granted or is received after the deadline, it is the responsibility of the employee to find coverage should they still need the time off.
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