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 Mollie Stout
428 Dalton Floyd
429 Joshua Warinner
430 Jeanie Brown
431 Donnie Hutchins
432 Michael Raleigh
433 Matt Messenger
434 Sierra Campbell
435 Rebecca Poff
436 Ashely Boyd
437 Josh Roark
438 Jordan Davis
439 Chas Anderson
440 Scott Burdine
441 Austin Young
442 Julie Howell
443 Brandon Douglas
444 Robert Roeder
445 Chelsea Blasingim
446 Glenn Blevins
447 Chad Begley
448 Jaden Inabnitt
449 RETIRED (B. STEVENSON)
450 Tessica Feaster
451 Casi Carpenter
452 Tanner Whitaker
453 Cory Ehrsam
454 Sable Jones
455 Jagger Keller
456 Michael Rogoski
457 Dennis McWhorter
458 David Phillippi
459 Alison Barnes
460 Baily Haynes
461 Josh Pence
462 Billy Floyd
463 Austin Tarter
464 Cody Loveless
465 PT Medic
466 Andrew McGarvey
467 PT Medic
468 PT Medic
469 PT Medic
470 Jimmie Foster
471 Robert Bessinger
472 Elijah Cochran
473 Mike Adams
474 Ashley Metcalf
475 PT AEMT
476 Sara Etzel
477 Ashley Burton
478 PT AEMT
479 Teddy Tweedy
480 Cody Perkins
481 Craig Goodin
482 Kevin Frye
483 Dave Miller
484 John Brainard
485 PT AEMT
486 PT AEMT
487 PT AEMT
488 PT AEMT
489 PT EMT
490 PT EMT
491 Ahmad Iqbal
492 PT EMT
493 RETIRED (C. MCWHORTER)
494 PT EMT
495 PT EMT
496 PT EMT
497 PT EMT
498 PT EMT
499 Matthew Coomer
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
