Scheduling Permanent Needs  Request Form

1. Location of Shift

   Asics Bay Club Beacon Hill Birch Brookfield Cherry Bud Chingford Coventry Dayhab Eastham Everwood Farr Glenmawr #1 Glenmawr #2 Grove City Hafton Hampton Harris Hiler Hunter#1 Hunter#2 Janet Drive Kenbrook Leap Rd Linwood Mallard Maple Bend Mead Miller Morse Rd Norris Near Noam Ct Orchard Parkgreen Red Ash Redmond Rolling Hills Sandlin Santiago Somerford Sturbridge Sunset Taunton Way Varadero Weyant#1 Weyant#2 Weyant#3 Westbrook Winchester Pike
   

2. Month of Shift Request

   January Febuary March April May June July August September October November December
   

3. Date of Shift

   Shift Hours Requested

   
   

4. Work Email Address

   
   

   First and Last Name (if you do not have approved email form)*

   Please provide a contact number for shift confirmation phone call*

    

5. Comments/Further Explanation (if needed)

   
   

*These hours must be confirmed by scheduling coordinator.  Do not show up for shift without confirmation.

* Approved email form: @cchs,@pwca, @scl-col.org