Calendar Update Request Form

Calendar Update Request Form

Clipboard - Hospitals
Important Note:
- Make sure to complete all required fields, including your full name, registered email address, the hospital where you're scheduled to work, and the relevant shift details.
- Please do not use this form if you are currently not part of a PRN pool or do not have an active assignment at the hospitals listed below.
- Please do not upload your timesheet sheet using this form. Timesheets should be uploaded directly in the Clipboard app by navigating to:
  Bookings > Unverified Shifts > Locate the shift in question > Upload Timesheet.
- If you are working for a Select Medical Hospital, you're required to send screenshot(s) of your schedule in the "When I Work" app below. Otherwise, the shifts will not be added.
Full Name:*

First NameLast Name
Email Address:*
example@example.com
Hospital Name:*
Note: Please submit another form if it's for multiple hospitals.
Who's your assigned recruiter?*
What is your request?*

Add Shifts - New shift needs to be reflected on the calendarUpdate Shifts – Modify existing shifts (e.g., shift swap, shift time change)Remove Shifts – Remove shifts canceled by the hospital (Only applicable for scheduled shifts at Select or Kindred Hospitals)
For non-Select Medical Hospitals, please put the shift details below using this format (Ex. 04/14 PM, 7 PM - 7 AM)
Note: If there are missing details, it might result in your shifts not being added.
Screenshot/Image of your Calendar:

Cancelof
Should be Empty: