{"id":4056,"date":"2026-06-27T23:06:44","date_gmt":"2026-06-27T23:06:44","guid":{"rendered":"https:\/\/assistinghands.com\/85\/?page_id=4056"},"modified":"2026-06-27T23:29:28","modified_gmt":"2026-06-27T23:29:28","slug":"caregiver-time-off-request","status":"publish","type":"page","link":"https:\/\/assistinghands.com\/85\/illinois\/palos\/caregiver-time-off-request\/","title":{"rendered":"Caregiver Time Off Request"},"content":{"rendered":"<section class=\"l-section wpb_row height_medium\"><div class=\"l-section-h i-cf\"><div class=\"g-cols offset_small\"><div class=\"vc_col-sm-12 wpb_column vc_column_container\"><div class=\"vc_column-inner\"><script type=\"text\/javascript\">if(!gform){document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0});var gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),null==t&&(t=10),gform.hooks[o][n].push({tag:i,callable:r,priority:t})},doHook:function(o,n,r){if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[o][n]){var t,i=gform.hooks[o][n];i.sort(function(o,n){return o.priority-n.priority});for(var e=0;e<i.length;e++)\"function\"!=typeof(t=i[e].callable)&&(t=window[t]),\"action\"==o?t.apply(null,r):r[0]=t.apply(null,r)}if(\"filter\"==o)return r[0]},removeHook:function(o,n,r,t){if(null!=gform.hooks[o][n])for(var i=gform.hooks[o][n],e=i.length-1;0<=e;e--)null!=t&&t!=i[e].tag||null!=r&&r!=i[e].priority||i.splice(e,1)}}}<\/script>\n                <div class='gf_browser_gecko gform_wrapper gravity-theme' id='gform_wrapper_2' style='display:none'><div id='gf_2' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">Employee Request for Time Off<\/h2>\n                            <span class='gform_description'><\/span>\n                        <\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_2' id='gform_2'  action='\/85\/wp-json\/wp\/v2\/pages\/4056#gf_2' novalidate>\n                        <div class='gform_body gform-body'><div id='gform_fields_2' class='gform_fields top_label form_sublabel_below description_below'><div id=\"field_2_1\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_2_1' >Employee Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_1' id='input_2_1' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_2_2\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_2_2' >Requested Days Off<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_2' id='input_2_2' type='text' value='' class='large'    placeholder='e.g. Jan 15 - Jan 17' aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><fieldset id=\"field_2_3\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label'  >Type of Time Off<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_3'>\n\t\t\t<div class='gchoice gchoice_2_3_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_3' type='radio' value='Two Week Notice'  id='choice_2_3_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_3_0' id='label_2_3_0'>Two Week Notice<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_3_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_3' type='radio' value='Sick Time'  id='choice_2_3_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_3_1' id='label_2_3_1'>Sick Time<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_3_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_3' type='radio' value='Unpaid Time Off'  id='choice_2_3_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_3_2' id='label_2_3_2'>Unpaid Time Off<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_4\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_2_4' >Employee Signature (Type Full Name)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_4' id='input_2_4' type='text' value='' class='large'    placeholder='Type your full name' aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_2_5\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_2_5' >Date<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_5' id='input_2_5' type='text' value='' class='datepicker mdy datepicker_with_icon gdatepicker_with_icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_2_5_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_2_5_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_2_5' class='gform_hidden' value='https:\/\/assistinghands.com\/85\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_2_6\" class=\"gfield gsection field_sublabel_below field_description_below gfield_visibility_visible\" ><h3 class=\"gsection_title\">For Manager Use Only<\/h3><\/div><fieldset id=\"field_2_7\" class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\" ><legend class='gfield_label'  >Decision<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_2_7'>\n\t\t\t<div class='gchoice gchoice_2_7_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='Approved'  id='choice_2_7_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_7_0' id='label_2_7_0'>Approved<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_7_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='Not Approved'  id='choice_2_7_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_2_7_1' id='label_2_7_1'>Not Approved<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_2_8\" class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_2_8' >Reason (if Not Approved)<\/label><div class='ginput_container ginput_container_text'><input name='input_8' id='input_2_8' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_2_9\" class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_2_9' >Manager Signature (Type Full Name)<\/label><div class='ginput_container ginput_container_text'><input name='input_9' id='input_2_9' type='text' value='' class='large'    placeholder='Type full name'  aria-invalid=\"false\"   \/> <\/div><\/div><div id=\"field_2_10\" class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_2_10' >Manager Date<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_10' id='input_2_10' type='text' value='' class='datepicker mdy datepicker_with_icon gdatepicker_with_icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_2_10_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_2_10_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_2_10' class='gform_hidden' value='https:\/\/assistinghands.com\/85\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_2_12\" class=\"gfield gfield--width-full field_sublabel_below field_description_below hidden_label gfield_visibility_visible\" ><label class='gfield_label' for='input_2_12' >CAPTCHA<\/label><div id='input_2_12' class='ginput_container ginput_recaptcha' data-sitekey='6LcwRzktAAAAAAmwx75qQgQkcu_3rQcZ6eGz-Q7V'  data-theme='light' data-tabindex='0'  data-badge=''><\/div><\/div><div id=\"field_2_11\" class=\"gfield gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible\" ><hr style=\"margin: 30px 0\">\n\n<p><strong>This form must be submitted prior to two weeks notice of time off.<\/strong> Submit by email: <a href=\"mailto:Ccruz@assistinghands.com\">Ccruz@assistinghands.com<\/a><\/p><p>Requested time off is not guaranteed and you must retain a signed copy for your 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