REQUEST FOR TIME OFF

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Request for Time Off

EMPLOYEE REQUEST FOR TIME OFF

Please fill out the form below if you would like to officially request time off. Your Supervisor will receive a copy of this form (please enter their email correctly below) and a copy will be sent to Head Office HR department.

Your Supervisor must approve any requests for time off before they can be taken. Please follow up with your Supervisor for any questions.

Request for Time Off

Employee Name:*
First Last
Employee Email:*
Office Location:*
Manager's Name:*
First Last
Manager's Email (they will be copied on this request):*
Start Date of Requested Leave:*
Date Format: MM slash DD slash YYYY
End Date of Requested Leave (leave blank if unknown):
Date Format: MM slash DD slash YYYY
Type of Absence Requested:*
Please describe the reason(s) for your requested time off:
By submitting this form, I acknowledge that all information is accurate and that the requested time off must be approved by my supervisor.*
- Yes

Locations Served

Nurse-Supervised Care!

All of our client services include Case Management by a Registered Nurse. This professional service is completely free of charge!

Our experienced Nurse Case Managers will design a specialized program that caters to your specific health care needs, your personal preferences and budget.

The Nurse Case Manager will meet with you regularly to ensure that you are receiving proper care and completely satisfied with your caregivers. No matter what your situation is, we will work with you to ensure you are safe, comfortable, and satisfied.

Learn More

Contact us today for a Free Nurse Consultation to discuss your medical needs, preferences and budget. With no contracts and no minimum hours, we will find the right solution!

Affinity Health is a professional, Canadian-owned company offering customized home and health care solutions to people of all ages.

Affinity Health, Head Office

2 Sheppard Ave E #1510
North York, ON M2N 7E7, Canada

Office: 416-322-9991
Client Enquiries: 1-800-565-CARE

info@affinityhealth.ca