MyTime Supervisor Request Form

Employee Name*
First Last
Supervisor Name*
First Last
Supervisor's Email Address*
Supervisor*
- I certify that I am the supervisor of the above employee.
Type of Request*
Please submit one form per request.
- Leave Request
- Permanent Lunch Adjustment
- Permanent Schedule Adjustment
Leave Request*
Select the appropriate leave category.
Submit supporting documentation for the following categories to the HR Benefits Administrator:
Bone Marrow
Disaster Leave
Fire/EMS Community Service
Jury-Civil Work Related
Military Leave
Public Health Emergency
Documentation for the following category should be retained by the Supervisor:
Education Leave
Total Number of Hours*
Enter the total number of hours requested
Lunch Adjustment*
Select the appropriate lunch period
Effective Date*
Select the date the request will become effective.
Contact Me
- I would like the Payroll Department to contact me about making schedule adjustment changes within MyTime.
Description of Schedule Adjustment
Provide a description of your schedule which includes in and out times. Example: Monday-Friday 7:30a-4:30pm