Pember Companies Time Off Request Application

Time Off Request Form Fields

• Employee Name:

• Employee #:

• Time Off Start Date:

  Date

• Time Off End Date:

  Date

• Total Number Of Days Off Work:

• Please Indicate The Type & Total Days Below:

• Field Employees are Entitled to 3 unpaid Personal Days After Completion of 1 Year of Service. More Than 2 Personal Days Requires 2 Weeks Notice.

• Personal Days:

• Field Employees are Earn 5 Vacation Days At The Start of Their 11th Year of Service. Personal Days Are Not Available to Employees if They Have Earned Vacation. Vacation Days Require 3 Weeks Notice.

• Vacation Days:

• See Employee Handbook for terms and Conditions of Paid and Unpaid Funeral Leave.

• Funeral Leave:

• Time Off for Doctor or Dental Visits, FMLA, or any special Request Not Including Personal Days While Available to Employee.

• Other Time Off:

• Employee Signature & Date:

  Sign

• Foreman's Signature & Date:

  Sign

• Operation's Manager Signature:

  Sign