Use this form to submit a Time Off Request to our office.


• All requests are granted on a first come, first serve basis.

• All requests should be submitted at least two weeks prior to the requested dates.

• Requests off submitted less than 2 weeks prior will be considered a call off and may affect Bonus Eligibility for the quarter.

• Every effort will be made to grant time off requests;

in some circumstances, in order to provide consistent services to our clients, we may only be able to grant time off to the employees who submit their requests first.

• If you are requesting paid time off, please put the number of

paid hours in the notes section.

• Paid time off is paid 8 hours per day off and may not be used as overtime hours.

Home Instead Senior Care
   9191 R G Skinner Pkwy Suite 803  
   Jacksonville, FL 32256 
   P: (904) 363-6699
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