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

WA 509-293-7993
OR 503-342-3420
Vacation or
Time Off Request
Time Off Requests must be submitted to:
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?
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?
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

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