TIME OFF / CASH OUT REQUEST FORM Today's Date Team Member Name * Supervisor Name * -- Select Position -- AP/ Payroll Specialist AR Specialist Assistant Estimator Assistant Project Manager BI Developer CAO CEO CFO Estimator File Clerk Foreman General Superintendent HR Manager Operator Pipelayer 1 Pipelayer 2 Pipelayer Helper Project Coordinator Project Management Project Engineer Project Manager Senior Estimator Senior HR Manager Senior Project Manager Superintendent Orientation Foreman Recruiting and Development Manager Office Manager and Special Projects Coordinator Lead Orientation Foreman IT Technician Project Coordinator Estimating Lead Estimator HR Assistant Accounting Clerk pending delete - 4/5/19 FOREMAN Recruiter SharePoint Developer SharePoint Architect HR Generalist IT Support Specialist SharePoint Power User SharePoint Systems Analyst Controller Assistant Controller IT Manager Assistant Super Brand Ambassador Time Off Request that automatically uses PTO (if available): Court School and Child Care Activities Medical Appointment Sick Bereavement Vacation Other 1. Preferred Dates: 2. Alternative Dates: This request form must be submitted a minimum of 72 hours for individual days; a minimum of 30-days before anticipated vacation of 5 days or more to receive preferential consideration. All requests must be pre-approved by a Supervisor. Time Off Request electing use of PTO (if available): Use PTO?: -- Select Use PTO? -- YES, use my PTO NO, Do NOT use my PTO Reason: -- Select Reason -- Jury Duty/Witness No Work Available Rain Day Leave of Absence Request: Type of Leave: -- Select Type of Leave -- Medical FMLA Beginning On: Returning On: Total # Days: PTO Cash Out: # Of Hours To Be Cashed Out: (up to 80 hours per year) 12 months of employment required. Request must be submitted by end of the 1st full week in December. Remarks: By submitting this form, I am confirming that I have discussed this request with my supervisor and it has been conditionally approved.
