Sick Time Off Request
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SOMERSET-PULASKI COUNTY EMS
SICK TIME OFF REQUEST
USE ONLY ONE (1) FORM PER DAY OFF.
Employee Name *
Select an Option
400 Tracy Sizemore, Chief
401 RETIRED (P. ENGLAND)
402 Matt Johnson, Major
403 Nancy Whitis, Major
404 Robert Campbell, Major
405 Jeremy Compton, Capt. / TC
406 Jessie Hamm, Capt.
407 Ernie Acton, Capt.
408 Gerardo Garcia, Capt.
409 Autumn Beggan, Capt.
410 Evan Stout, Lt.
411 Chelsea Quillen, Lt.
412 Nicholas Bush, Lt.
414 Open, Lt.
415 Selena Ehringer
416 Kevin Campbell
417 Robert Mounce
418 John Rusin
419 Logan Gibson
420 Brandon Clark
421 FT Medic
422 FT Medic
423 FT Medic
424 FT Medic
425 FT Medic
426 FT Medic
427 FT Medic
428 FT Medic
429 FT Medic
430 FT Medic
431 Donnie Hutchins
432 Jeanie Brown
433 Joshua Warinner
434 Matt Messenger
435 Josh Roark
436 Rebecca Poff
437 Sierra Campbell
438 Dalton Floyd
439 Dennis McWhorter
440 Ashely Boyd
441 Michael Raleigh
442 Mollie Stout
443 FT AEMT
444 Julie Howell
445 Brandon Douglas
446 Robert Roeder
447 Glenn Blevins
448 Casi Carpenter
449 RETIRED (B. STEVENSON)
450 Chelsea Blasingim
451 Jagger Keller
452 Michael Rogoski
453 Chas Anderson
454 Alison Barnes
455 Baily Haynes
456 Jordan Davis
457 Chad Begley
458 Tessica Feaster
459 Jaden Inabnitt
460 Cory Ehrsam
461 Sable Jones
462 Tanner Whitaker
463 David Phillippi
464 Austin Young
465 Josh Pence
466 Andrew McGarvey
467 Austin Tarter
468 Jimmie Foster
469 Mike Adams
470 Elijah Cochran
471 Ashley Metcalf
472 Robert Bessinger
473 Cody Loveless
474 Billy Floyd
475 PT Medic
476 PT Medic
477 PT Medic
478 PT Medic
479 PT Medic
480 Kevin Frye
481 Sara Etzel
482 Teddy Tweedy
483 Craig Goodin
484 Cody Perkins
485 Ashley Burton
486 PT AEMT
487 PT AEMT
488 PT AEMT
489 PT EMT
490 Dave Miller
491 Ahmad Iqbal
492 Matthew Coomer
493 RETIRED (C. MCWHORTER)
494 John Brainard
495 PT EMT
496 PT EMT
497 PT EMT
498 PT EMT
499 PT EMT
C-1 Bengie Howard
BC-1 Samuel Hudson
BC-2 Coby Dykes
BC-3 Kenny Shepherd
FM-1 Jayce Shepperd
100 Chris Meece
102 Nick Cantrell
103 Mike Phelps
110 James Rogers
112 Justin Foster
113 Bryan West
114 Shannon Hamm
115 Creig Bradley
116 Nathan Thayer
120 Zeke Reynolds
121 Matt Miller
122 Jeremy Nelson
123 Joey Vaughn
124 Jason Cundiff
125 Chris Hall
126 Travis Chase
127 Joshua Davis
128 Travis Richardson
129 Matt Burton
130 James Martin
131 Daniel Clark
132 Josh Inman
133 Cody King
134 Phillip Rogers
135 Brett England
136 Rob Garland
137 Tim Ferrell
138 Hunter Frye
139 FT FF
140 Zach Nicolson
141 Crystal Norton
142 Austin Mercer
143 Morgan Quick
144 Jared Spiro
145 Michael Yates
147 Frank Votolato
149 Nate Looney
153 Robert Mueller
Date
Time
Date Requested Off: *
Person Filling Out This Request *
Time Period:
Time *
To
Time *
Total Hours: *
THIS FORM IS FOR USE OF SICK TIME ONLY
Person(s) To Be Notified (use A Comma To Separate Email Addresses; Do Not Add a Space After the Comma)
Office Use Only
Date
Time
OIC / MAJOR
Edit
Clear
Admin Use Only
Approved:
Yes
No
If Denied, Reason:
Major
Edit
Clear
Chief
Edit
Clear
*COPY TO OFFICE MANAGER AND HUMAN RESOURCES
ORDER OF REQUEST FOR DATE:
NUM
OF
NUM
