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2. Employee Name*
3. Date*
   Date
5. Department*
6. Compensation*

   1. Paid
   2. Unpaid
8. Type of Request*
   -- Select One --VacationSickFloating HolidayOther
9. Hours Requested*
10. From*
    From
11. To*
    To
13. Employee Remarks
15. Submit to:*
    -- Select One --Kevin AshTodd NorrisJason LeslieBob BedsaulDave EganJared BakesJennifer SimmonsRusty RibbleSarah TroyJohn OberKent VanDyneMeghan MartinezIan AlbertKirstyn JovanovichBrent ManleyBrian OstlerAngela Wilson
17. My Email:*
    Provide email, so your supervisor can send a response regarding your request.
19. Human Resources Notification
    Supervisors: Once approved, please make sure to forward response to the Human Resources Director. LMueller@frederickco.gov
Leave This Blank:


22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit Submit and Print

* indicates a required field