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Event Series:
Independence Day
Independence Day
June 4
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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)
Employee Email
(Required)
Full Week Dates Requested
Week 1: Start Date
MM slash DD slash YYYY
Week 1: End Date
MM slash DD slash YYYY
Week 2: Start Date
MM slash DD slash YYYY
Week 2: End Date
MM slash DD slash YYYY
Week 3: Start Date
MM slash DD slash YYYY
Week 3: End Date
MM slash DD slash YYYY
Week 4: Start Date
MM slash DD slash YYYY
Week 4: End Date
MM slash DD slash YYYY
Individual Days Requested
Day Request 1
MM slash DD slash YYYY
Day Request 2
MM slash DD slash YYYY
Day Request 3
MM slash DD slash YYYY
Day Request 4
MM slash DD slash YYYY
Day Request 5
MM slash DD slash YYYY
Day Request 6
MM slash DD slash YYYY
Day Request 7
MM slash DD slash YYYY
Day Request 8
MM slash DD slash YYYY
Day Request 8
MM slash DD slash YYYY
Day Request 10
MM slash DD slash YYYY
Total # of Days Requested:
(Required)
Please select how you would like to receive your check:
(Required)
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Please provide the last 4 of the acct number
Signature
(Required)
Today's Date
(Required)
MM slash DD slash YYYY
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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