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Radiology Exempt Staff

Request for Time-Off (RTO)


In order to process your Request for Time-Off, you will need to complete the following form. The request will be submitted to your supervisor who will then contact you as to the status of your request. If you do not receive a reply within a week of submission, please contact your supervisor directly.

Note: You must arrange appropriate coverage during your absence.

  1. Name:

  2. E-mail Address:

  3. Supervisor E-mail:


  4. RTO Type:

    Scheduled Sick
    Vacation
    Optional Holiday

    Cancel Prior RTO

  5. Date(s) Requested:

    First Day:
    Last Day:  
    Total Days Requested:

  6. Back-up Coverage Provided by:


 

 

 

  
Note: You must arrange appropriate coverage during your absence.

 

 
 


Document last modified Thursday, March 16, 2006.
© 2002 University of Southern California