LSJ, LLC
6100 Red Hook Quarters Suite 8-3 St. Thomas, VI 00802-1348 Tel: 340-7754100 Fax: 340-775-8108
E-mail:
Vacation / Leave Form
Name:
Date of Request: 5/26/10
Dates ofRequested:
Date of First Day of Vacation: June 7, 14, 21, 28 Date Return to Work June 8, 15, 22, 29
Total Number of Days:
Leave Days: 3 Weekend Days: Holidays: 1 Personal / Sick : Days &maw: 48 Days
Type ofLeave:
61 Vacation with Pay Leave without pay Personal Sick Leave Other
If Other Explain: Holiday - New Years 2010
List ofall contact information:
Phone:
Cell:
Email:
I
The following must be verified with Estate Manager
1. The number of vacation days you have taken.
2. The number employee in your division / department that are leave at the same time
Approved:
EFTA00730610