Employee- staff – arrival and attendance change, vacation & sick time request

Dear staff member of Bodhi Medical,

To improve our organization and management, please utilize this online form to submit your report for reasons such as: being late to work, unable to come to work, request vacation time, request time off or change in schedule, request near future sick time absence.

To submit your request for sick time reimbursement under the sick time law please continue to use the form: http://www.mybodhi.com/forms/sicktime-requestform.pdf , Once you print the form, please either fax it to : 2126240220 or email it to drm@mybodhi.com and payroll@mybodhi.com

Please note that any sick time request must be submitted as soon as forseen and for any extended time off especially over 3 days, doctor’s note must be submitted as applicable under the law.
For more information please visit: http://www1.nyc.gov/site/dca/about/paid-sick-leave-law.page

First name (*) :

Last name (*) :

Best contact email (*) :

Best contact phone (*) :

Reason for request (*) :

Please provide additional details of your request: :

I expect to be / return to work at this time & date (*) :

I wish to also notify the provider/ staff member I closely work with who will be affected by my absence:
Affected doctor’s email (*) :

Office MA coordinator email (*) :

My back up MA-1 email (*) :

My back up MA-2 email (*) :

I hereby confirm that the information above is submitted by me, the person’s whose first and last name appears at the top of this form and I further confirm that the information above submitted is truthful and accurate to the best of my knowledge. I understand that false or fraudulent reports or requests may result in employment sanctions included but not limited to reduction in pay and/or termination.

Please sign your request (*) :

Type the characters you see in the picture below:
captcha

(*) Required fields