Holiday Request Form England & Wa

Week
Commencing

Employee no: 3/28/2021

Your First Name: joe 4/4/2021
Your Surname Name: bloggs 4/11/2021
Date of Joining (DD/MM/YYYY) 1/21/2000 4/18/2021
Contracted hours 40 4/25/2021
Your base store number 7000 5/2/2021
Select Your Job Title: Pharmacist 5/9/2021
No. of Bank Holidays This Year: 8 5/16/2021
Holiday Adjustment HOURS (+/-) (Benefits Box etc.): 5/23/2021
Total Holiday Entitlement (excluding Bank / Public Holidays): 240 5/30/2021
6/6/2021
6/13/2021
6/20/2021
6/27/2021
7/4/2021
7/11/2021
7/18/2021
7/25/2021
8/1/2021
8/8/2021
8/15/2021
8/22/2021
8/29/2021
9/5/2021
9/12/2021
9/19/2021

Cluster 1

Please indicate 3 first choices and 3

choices (part time pro-rata) for Pub
you wish to work. Please select on
Holiday from each cluster (Blue and
the 3rd selection can be from eithe

Cluster 2
rm England & Wales Holiday hours left to book
exluding Bank holidays
Planner 1st / Total
Rotation 2nd S M T W T F S Hrs Comments Auth'd?
Week
Choice Rqstd
1 0
1 0
1 0
2 0
1 0
1 0
1 0
1 0
1 0
1 0
1 0
1 0
1 0
1 0
1 0
1 0
1 0
1 0
1 0
1 0
1 0
1 0
1 0
1 0
1 0
1 0

Public Holiday 1st Choice Requested Lieu Date 2nd Choice

Fri 02/04/2021 no no
ease indicate 3 first choices and 3 second
oices (part time pro-rata) for Public Holidays Mon 05/04/2021 no no
u wish to work. Please select one Public Mon 03/05/2021 no no
liday from each cluster (Blue and Red) and
e 3rd selection can be from either cluster. Mon 31/05/2021 no no
Mon 30/08/2021 no no
Public Holiday 1st Choice Requested Lieu Date 1st Choice
Mon 27/12/2021 no no
Tue 28/12/2021 no no
Mon 03/01/2022 no no
eft to book 240
olidays
Planner 1st / Total
Week
Commencing
Rotation 2nd S M T W T F S Hrs Comments
Week
Choice Rqstd
9/26/2021 1 0
10/3/2021 1 0
10/10/2021 1 0
10/17/2021 1 0
10/24/2021 1 0
10/31/2021 1 0
11/7/2021 1 0
11/14/2021 1 0
11/21/2021 1 0
11/28/2021 1 0
12/5/2021 1 0
12/12/2021 1 0
12/19/2021 1 0
12/26/2021 1 0
1/2/2022 1 0
1/9/2022 1 0
1/16/2022 1 0
1/23/2022 1 0
1/30/2022 1 0
2/6/2022 1 0
2/13/2022 1 0
2/20/2022 1 0
2/27/2022 1 0
3/6/2022 1 0
3/13/2022 1 0
3/20/2022 1 0
3/27/2022 1 0

Requested Lieu Date

DATE SUBMITTED:_____________

Requested Lieu Date

Auth'd?
 holiday
entitlement Holiday
Pharmacist Pharmacist Base Store (excluding bank hours Holiday hours
first name Surname No. holidays) planned remaining 28-Mar 4-Apr
joe bloggs 7000 240 0 240 0 0
Second Choice 0 0

1 yes
2 no
11-Apr 18-Apr 25-Apr 2-May 9-May 16-May 23-May 30-May 6-Jun 13-Jun
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
20-Jun 27-Jun 4-Jul 11-Jul 18-Jul 25-Jul 1-Aug 8-Aug 15-Aug 22-Aug
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
29-Aug 5-Sep 12-Sep 19-Sep 26-Sep 3-Oct 10-Nov 17-Oct 24-Oct 31-Oct
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
7-Nov 14-Nov 21-Nov 28-Nov 5-Dec 12-Dec 19-Dec 26-Dec 2-Jan 9-Jan
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
16-Jan 23-Jan 30-Jan 6-Feb 13-Feb 20-Feb 27-Feb 6-Mar 13-Mar 20-Mar
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
 Easter Christmas New Years
27-Mar Good Friday Monday Early May Late May August Day Boxing Day Day 04/-1/2022
0 8 8 8 8 8 8 8 8 0
0 8 8 8 8 8 8 8 8 0