EFTA01223548.pdf

LSJE, LLC 6100 Red Hook Quarters, Suite B-3, St. Thomas, VI 00802-1348 Phone: E-mail: Vacation/Leave Form 'Gerry Anthony Titre Name: Cell: Division/Department: I Maintenance/RO Phone (other): Date Request Submitted: 01/09/19 E-mail: Dates of Vacation/Leave Requested: Date of Vacation/Leave to Begin: 102/21/19 Date of Return to Work 03/11/19 Number of employees in your division/department expected to be absent during your requested vacation/leave?* 0 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: 12 Number of vacation days granted per this request: Leave without Pay: 0 Number of vacation days remaining after this request: Personal/Sick Days: 0 Holidays: 0 Number of medical days permitted annually Weekend Days: Number of medical days used year-to-date: Other:" 0 Number of medical days granted per this request: Total Days Away: 118 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 wilt be approved. EFTA01223548