EFTA01223545.pdf

LSJE,LLC 6100 Red Hook Quarters, Suite B-3, St. Thomas, VI 00802-1348 Phone: E-mail: Vacation/Leave Form Cuthbert Titre Name: Cell: Division/Department: Phone (other) Date Request Submitted: 12/17/18 E-mail: Dates of Vacation/Leave Requested: Date of Vacation/Leave to Begin: 101/02/19 Date of Return to Work 01/07/18 Number of employees in your division/department expected to be absent during your requested vacation/leave?* For internal use only: Total Number of Days Away: Number of vacation days permitted annually: Number of vacation days used year-to-date: Vacation with Pay: 3 Number of vacation days granted per this request: Leave without Pay: Number of vacation days remaining after this request: Personal/Sick Days: ■ Holidays: Number of medical days permitted annually: Weekend Days: Number of medical days used year-to-date: Other:" ■ Number of medical days granted per this request: Total Days Away: I5 I Number of medical days remaining after this request: "If 'Other,' please explain: Employee Signature: Date: Authorization: Approval Date: •Areas indicatedmust be verified with the supervisor before vacation/leave will be approved. EFTA01223545