Allied Communications, Inc.

REQUEST FORM FOR DAYS OFF OR VACATION

                                       
  Name: ________________________________________________________  
  Date Prepared____________________________________  
                                       
                                       
  Please List Exact Dates and Reason  
 

CHOICE

DATES

REASON

1st From       to          

2nd From       to          

3rd From       to          

 
   
   
  ***REQUEST MUST BE SUBBMMITTED AT LEAST 14 DAYS PRIOR REQUESTED DAYS OFF AND MUST BE OK'D BY YOUR SUPERVISOR***  
  APPROVED:          YES  _______________  NO  _______________  
  PAID:                       YES  _______________  NO  _______________  
                                       
  SUPERVISOR:__________________________________     DATE: ______/______/_________  
  STEVE FREEMOLE:_____________________________    DATE: ______/______/_________  
                                       
                                       
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