EFTA00305862.pdf

LSJ, LLC 6100 Red Hook Quarters Suite B-3 St. Thomas, VI 00802-1348 E-mail: Vacation / Leave Form Name: Date of Request: 11/27/11 Dates of Requested: Date of First Day of Vacation: Total Number of Days: December 12th, 2011 Leave Days: 2 i Weekend Days: Type of Leave: 2 Holidays: C Vacation with Pay C Leave without pay If Other Explain: 3 Date Return to Work: Personal / Sick: r Personal Sick Leave Other December 19th, 2011 Days Remaing: 58 days Holidays - Labor Day, Thanksgiving Day, Thanksgiving Friday List of all contact information: Phone: Cell: Email: The following must be verified with Estate Manager 1. The number of vacation days you have taken. 2. The number employee in your division / department that are leave at the same time Approved: EFTA00305862 LSJ, LLC 6100 Red Hook Quarters Suite B-3 St. Thomas, VI 00802-1348 Tel: 340-775-8100 Fax: 340-775-8108 E-mail: Vacation / Leave Form Name: Date of Request: 11/27/11 Dates of Requested: Date of First Day of Vacation: Total Number of Days: Weekend Days: Leave Days: Type of Leave: r Vacation with Pay C' Leave without pay 2 December 12th, 2011 2 If Other Explain: Holidays: 3 Date Return to Work: Personal / Sick: r Personal Sick Leave C Other December 19th, 2011 Days Remising: 60 days Holidays - Labor Day, Thanksgiving Day, Thanksgiving Friday List of all contact information: Phone: Cell: Email: The following must be verified with Estate Manager 1. The number of vacation days you have taken. 2. The number employee in your division / department that are leave at the same time Approved: EFTA00305863