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Vacation Request

Please note that requests must be received by 4pm on Tuesday in order for any eligible checks to be written the same week.

Company Name(Required)

Employee Name(Required)

Full Week Dates Requested

Week 1: Start Date

Week 1: End Date

Week 2: Start Date

Week 2: End Date

Week 3: Start Date

Week 3: End Date

Week 4: Start Date

Week 4: End Date

Individual Days Requested

Day Request 1

Day Request 2

Day Request 3

Day Request 4

Day Request 5

Day Request 6

Day Request 7

Day Request 8

Day Request 10

Total # of Days Requested:(Required)

Please select how you would like to receive your check:(Required)

Mail It

Pick It Up

Direct Deposit

Please provide the last 4 of the acct number

Signature(Required)

Today's Date(Required)

Please note the following conditions for Vacation Check Requests:

1. 2 weeks of vacation may be taken as individual days, all additional vacation time must be taken on consecutive days. Vacation time must be submitted in weekly increments (5 days, if available)

2. Holidays cannot be included as a vacation day. Checks can be written up to 30 days prior to the vacation dates submitted.

3. All vacation checks will be issued at the weekly rate outlined by your Journeyman status as of July 1st of the previous plan year.

4. Any check requests outside of these parameters must be submitted to the Vacation Committee for approval.

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Vacation Request

Full Week Dates Requested

Individual Days Requested

Please note the following conditions for Vacation Check Requests: