Time Off Request Form

First Name:

Last Name:

Email:

I would like to request these dates off: From: To: All day These times:

During these dates, I’m scheduled to work at:OceansideSan ElijoCommunity Learning Center

Will this request affect a scheduled classroom assignment? Yes If yes, provide Instructor(s): Class(es): No

Will you be using your accrued Healthy Families Leave (HFL) hours for this time off?
**According to the Healthy Workplaces, Healthy Families Act of 2014 (AB 1522), HFL time can be used for the following purposes: "diagnosis, care, or treatment of an existing health condition of, or preventative care for, yourself or a family member (parent, child, spouse, domestic partner, parent-in-law, sibling, grandchild or grandparent) or for specified purposes if an employee is a victim of domestic violence, sexual assault or stalking."
If Yes, then please also submit a request in Workday by clicking in the "Absence" icon and then "Request Absence" You will also be able to view your HFL available balance in that section. Yes No

Comments or questions about your request?