2. Shift*
   -- Select One --AdministrativeA/B Split ShiftC/D Split ShiftA ShiftB ShiftC ShiftD Shift
3. Total Hours*
5. Leave Request Shift*
   -- Select One --Day ShiftFirst Half Day ShiftLast Half Day ShiftNight ShiftFirst Half Night Shift Last Half Night Shift
6. Leave Type*
   -- Select One --Shift TradeVacation (02)Sick (03)Admin/TrainingPersonalFloating Holiday
8. Schedule*

   1. Unscheduled
   2. Scheduled
   3. 1st off
   4. 2nd off (complete contingency plan below)
10. Date
    Date
    Select Date
11. Date
    Date
    Select Date
13. Date
    Date
    Select Date
14. Date
    Date
    Select Date
16. Date
    Date
    Select Date
17. Date
    Date
    Select Date
19. Employee First Name*
20. Employee Last Name*
22. Employee Email*
24. Coverage
26. Contingency Plan
    Required if selected "2nd off" (above)
Leave This Blank:


28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit

* indicates a required field