TIME OFF / CASH OUT REQUEST FORM Today's Date Team Member Name * Supervisor Name * -- Select Position * -- Accounting Clerk AP/ Payroll Specialist AR Specialist Assistant Controller Assistant Estimator Assistant Project Manager Assistant Super BI Developer Brand Ambassador CAO CEO CFO Controller Estimator File Clerk Foreman General Superintendent HR Assistant HR Generalist HR Manager IT Manager IT Support Specialist IT Technician Lead Estimator Lead Orientation Foreman Office Manager and Special Projects Coordinator Operator Orientation Foreman pending delete - 4/5/19 FOREMAN Pipelayer 1 Pipelayer 2 Pipelayer Helper Project Coordinator Estimating Project Coordinator Project Management Project Engineer Project Manager Recruiter Recruiting and Development Manager Senior Estimator Senior HR Manager Senior Project Manager SharePoint Architect SharePoint Developer SharePoint Power User SharePoint Systems Analyst Superintendent 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.
