Same Day Crowns
Services
Preventive Dentistry
Restorative Dentistry
Sedation Dentistry
Oral Surgery
Cosmetic Dentistry
Orthodontics
Locations
Burnaby
Coquitlam
Langley
New Westminster
Coast Meridian
In Office Lab
Forms
Referral Form
New Patients Form
Request an Appointment
Staff Only
Same Day Crowns
Services
Preventive Dentistry
Restorative Dentistry
Sedation Dentistry
Oral Surgery
Cosmetic Dentistry
Orthodontics
Locations
Burnaby
Coquitlam
Langley
New Westminster
Coast Meridian
In Office Lab
Forms
Referral Form
New Patients Form
Request an Appointment
Staff Only
Home
/
Time Adjustment Request Form
Time Adjustment Request Form
Please submit this form to request your non-paid break time adjustment.
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Employee Name ( Last name, First name )
*
First
Last
Email
*
Job Title
*
Receptionist
Dental Assistant
RDH
Administration
Lab Technician
Work Date (D/M/Y)
*
Location
*
Burnaby
Tri-City
Langley
New Westminster
Coast Meridian
Actual Break Starting Time
Actual Break Ending Time
Total Break Time (minutes)
If you didn't have break time, please check the box below
No Break Time
Reason for Request
Submit Request
This form will be sent to the Dr.Lee and managers, James and Mark, for the time adjustment.