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 Steve Eubank, 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 Josh Morgan, Capt.
408 Ernie Acton, Capt.
409 Capt.
410 Lt.
411 Gerardo Garcia, Lt.
412 Autumn Beggan, Lt
414 Evan Stout, Lt.
415 Tina Davidson
416 Chelsea Quillen
417 Andrew McGarvey
418 Jimmie Foster
419 FT Medic
420 Selena Ehringer
421 Kevin Campbell
422 Robert Mounce
423 Cody Loveless
424 David Quillen
425 Luke Jansen
426 FT Medic
427 FT Medic
428 FT Medic
429 FT Medic
430 Jeanie Brown
431 Donnie Hutchins
432 Kevin Frye
433 Nicholas Bush
434 Sierra Campbell
435 Rebecca Poff
436 FT AEMT
437 FT AEMT
438 FT AEMT
439 FT AEMT
440 Scott Burdine
441 Mike Hinkle
442 Julie Howell
443 Brandon Douglas
444 Robert Roeder
445 Chelsea Blasingim
446 Glenn Blevins
447 Josh Warinner
448 Josh Roark
449 RETIRED (B. STEVENSON)
450 Matt Messenger
451 Casi Carpenter
452 John Rusin
453 Logan Gibson
454 Dalton Floyd
455 Jagger Keller
456 Michael Rogoski
457 Todd Branche
458 FT EMT
459 FT EMT
460 Josh Pence
461 Jason Baugh
462 Desirah Cowans
463 Brian Anderson
464 Samantha Warinner
465 Billy Crockett
466 Jhon Powell
467 Mike Short
468 Michael Osborne
469 Billy Floyd
470 Alex Shawen
471 Steve Marrs
472 Dustin Allred
473 Brandon Clark
474 PT Medic
475 Traci Bray
476 Sara Etzel
477 Mike Adams
478 Mollie Stout
479 Teddy Tweedy
480 Michael Raleigh
481 Kelsey Guidi
482 PT AEMT
483 Dave Miller
484 Cyndi Wilson
485 Jordan Davis
486 Austin Tarter
487 Chas Anderson
488 Kela Piatt
489 Scott Ungles
490 Angela Thomason
491 Ahmad Iqbal
492 Morris Skidmore
493 RETIRED (C. MCWHORTER)
494 Dennis McWhorter
495 Jason Hancock
496 Ashley Boyd
497 Alison Barnes
498 Baily Haynes
499 Sable Jones
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
