On Call/LCD Form

On Call/LCD Request Form

Request must be made 24 hours in advance of shift request.

Employee's Name:*
Email Address:*
Job Title:*
Department:*
Date Requesting On Call/LCD:*
Shift Requesting On Call/LCD (AM, PM, Day, Midshift, Evening Shift, Night Shift or Other):*
Today's Date:*
MM slash DD slash YYYY
Current Time:*

: Hours

Minutes

AM/PM

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