{"id":639,"date":"2015-11-17T16:57:15","date_gmt":"2015-11-17T21:57:15","guid":{"rendered":"https:\/\/med.virginia.edu\/orthopaedic-surgery\/?page_id=639"},"modified":"2015-11-18T10:19:43","modified_gmt":"2015-11-18T15:19:43","slug":"resident-leave-request-form-2","status":"publish","type":"page","link":"https:\/\/med.virginia.edu\/orthopaedic-surgery\/orthopaedic-education\/residency-program\/resident-resources-first-draft\/resident-leave-request-form-2\/","title":{"rendered":"Resident Leave Request Form"},"content":{"rendered":"<script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n\/* ]]> *\/\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_3' >\n                        <div class='gform_heading'>\n                            <h3 class=\"gform_title\">Resident Leave Request Form<\/h3>\n                            <p class='gform_description'>Please use the below form to request leave time.\r\n\r\nRequests will be reviewed by the Administrative Chief Residents and Program Directors.  Completion of this form is required to schedule any leave.  Please review the vacation policy from the resident handbook when requesting leave.  You must discuss potential leave with the service scheduler and chief resident of the service on which you will be rotating at the time of your absence.  Maximum total business days per year for leave: personal (10); course\/conference (5); professional including fellowship interviews (5).<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_3'  action='\/orthopaedic-surgery\/wp-json\/wp\/v2\/pages\/639' data-formid='3' novalidate><div class='gf_invisible ginput_recaptchav3' data-sitekey='6LebeGYrAAAAAP5BASaCDpdLeg5wBa6YY3ZS7nZh' data-tabindex='0'><input id=\"input_63df5d1a8538265bf77429563bee652e\" class=\"gfield_recaptcha_response\" type=\"hidden\" name=\"input_63df5d1a8538265bf77429563bee652e\" value=\"\"\/><\/div>\n                        <div class='gform-body gform_body'><ul id='gform_fields_3' class='gform_fields top_label form_sublabel_below description_above validation_below'><li id=\"field_3_19\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_19'>Instagram<\/label><div class='gfield_description' id='gfield_description_3_19'>This field is for validation purposes and should be left unchanged.<\/div><div class='ginput_container'><input name='input_19' id='input_3_19' type='text' value='' autocomplete='new-password'\/><\/div><\/li><li id=\"field_3_1\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_1'>Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_1' id='input_3_1' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_3_16\" class=\"gfield 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gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_3_3'>\n\t\t\t<li class='gchoice gchoice_3_3_0'>\n\t\t\t\t<input name='input_3' type='radio' value='Personal'  id='choice_3_3_0'    \/>\n\t\t\t\t<label for='choice_3_3_0' id='label_3_3_0' class='gform-field-label gform-field-label--type-inline'>Personal<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_3_3_1'>\n\t\t\t\t<input name='input_3' type='radio' value='Conference'  id='choice_3_3_1'    \/>\n\t\t\t\t<label for='choice_3_3_1' id='label_3_3_1' class='gform-field-label gform-field-label--type-inline'>Conference<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_3_3_2'>\n\t\t\t\t<input name='input_3' type='radio' value='Professional'  id='choice_3_3_2'    \/>\n\t\t\t\t<label for='choice_3_3_2' id='label_3_3_2' class='gform-field-label gform-field-label--type-inline'>Professional<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_3_4\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_4'>Leave Details<\/label><div class='gfield_description' id='gfield_description_3_4'>For conference and professional leave requests, please provide further information.<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_4' id='input_3_4' class='textarea medium'  aria-describedby=\"gfield_description_3_4\" maxlength='300'   aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_3_5\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_5'>Leave Begin Date<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_5' id='input_3_5' type='text' value='' class='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_3_5_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_3_5_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_3_5' class='gform_hidden' value='https:\/\/med.virginia.edu\/orthopaedic-surgery\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_3_7\" class=\"gfield gfield--type-date gfield--input-type-date 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value='https:\/\/med.virginia.edu\/orthopaedic-surgery\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_3_8\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_8'>Rotation<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_3_8'>(at time of requested leave)<\/div><div class='ginput_container ginput_container_text'><input name='input_8' id='input_3_8' type='text' value='' class='medium'  aria-describedby=\"gfield_description_3_8\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_3_14\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_14'>Other residents on service<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_14' id='input_3_14' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_3_15\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_3_15'>Notes<\/label><div class='gfield_description' id='gfield_description_3_15'>Please use this field if there are special circumstances associated with this leave request.<\/div><div class='ginput_container 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