Carlson Services Inc.
499 Rock Island Rd.
East Wenatchee, WA 98802

WA 509-293-7993
OR 503-342-3420
payroll@carlsonservices.com
www.carlsonservices.com
Vacation or
Time Off Request
Time Off Requests must be submitted to:
PAYROLL@CARLSONSERVICES.COM
FROM your CSI email account. Any discrepancies will be replied to that email address. Any time off must be pre-approved by your supervisor.
***Time off at the same time as other employees will not likely be approved due to difficulties this has caused in the past.
Check your information before submitting.
Employee Name:
Requested Date Range:
(## / ## - ## / ####)
This form must be completed and submitted to management at least 2 weeks prior to your requested time off start date. If submitted any later, it is not as likely to be approved.
Are you requesting PAID time off?
Yes
No
Select Shift Lengths:
Partial Day
Full Day
Multiple Days
1 Week or More
For All Selections, what time is needed off?
(i.e. 8:00-14:00 or Monday, Wednesday & Friday, Etc...)
Will you be available for contact while off?
Yes
No
If Yes, how? (Leave phone # &/or email)
Type of Leave Requested
Military (Verify in Details Box)
Sick / Medical
Jury Duty / Court Date(s) (Varify)
Personal (please briefly explain)
Reason for Request Details & Verification
I understand that the day(s) off that I have requested are not guaranteed to be approved. I also understand that the approval or disapproval of my request is based on the needs of the company and availability to cover shifts.
Yes, I understand and I am verifying below
Date and Time Submitted: (Sunday, ## / ## / 2013 @ 16:45)
Print the screen or press CTRL+P for a copy for your records

FOR SECURITY VARIFICATION;
Please enter your email address and last four digits of your Social Security number (###-##-1234)