STARS Time Off Request Form

STARS Plastic Surgery Time Off Request

Request a time off from work
Assigned Location *
Name *

First Name Last Name
Email *
example@example.com
Note that leave requests are due minimum 2 weeks prior to start. Exceptions have to be justified below.
Is your leave request a TDY? *

Yes No or you do not know what a TDY is
State TDY location and purpose *
Sick/Family leave *

I'm taking leave because of a personal illness I'm taking leave because of an illness of an immediate family member None of the above applies
COVID Related *

COVID-related or possibly related Not COVID related
Work from Home *

I have been authorized by my supervisor to work from home during this time I am at home awaiting test results for COVID-19 or I have a positive test for COVID-19 I have access to a reliable internet connection I have access to a quiet space conducive to work and away from distractions I understand that my computer maybe monitored to assess my productivity I understand that I will be putting in for additional PTO hours for the time that I have not been able to devote to work while I am at home
WorkHomeScore
You did not check off all the requirements for working from home.
PTO Start *

Month Day Year
Date Hour Minutes
PTO End *

Month Day Year
Date Hour Minutes
You have entered a date that is either before today or less than 14 days from now, please state the reason for your urgent leave request.
Reason for Urgent Request *
Employee Signature *

Clear
You have entered a PTO start date that is after the PTO end date. Please correct.
Should be Empty:

STARS Plastic Surgery Time Off Request