Time Off Request Form

The purpose of this form is to notify Chesapeake Caregivers in writing that you, permanently or temporarily, wish to be taken off an assignment. Below, please find questions regarding further details of the reason(s) why you are making this request. You must fill out ALL of the following questions. Any incomplete form will be interpreted as you are quitting employment with Chesapeake Caregivers.  Chesapeake Caregivers would like to reiterate our call out policy which is as followed:

If for any reason you need to call out of work, you must give Chesapeake Caregivers at least 24-notice. It is understandable that this may not be possible in all cases so please do your best to meet this requirement. A no-call no-show will result in loss of work opportunities and will be reported to the Maryland Board of Nursing and the Office of Health Care Quality as neglect. You must call the local Chesapeake Caregivers Office and speak directly to a member of the office staff when requesting time off. If you are requesting time off on short notice and are unable to inform a member of the Chesapeake Caregivers office staff during office hours (which are Monday – Friday from 8:30AM-4:30PM) then you must call the after-hour cell phone at 443-510-0398 and speak with an office staff member. ***Furthermore, you may not request off by leaving a voice message, text message, email, or by solely filling out this form, you must speak to a member of the office staff. Please understand that these processes are in place to keep our clients safe in their homes.