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					                                                                                      Reference Vacation Policy
                                               Human Resources                                Revision 1

                                                                                                     Form VI.1

                             INFORMATION AND STATUS CHANGE FORM

Employee ID      ______________________                Name:            ____________________

COMPLETE ONLY THOSE AREAS BELOW THAT REQUIRE A CHANGE

      Personal Information

Address:         ___________________________________________________________________
Home phone: ____________________________               Province:          ___________________
Marital Status: ____________________________           Date of Marriage: ___________________
                                                       Spouse Name:       ___________________
Emergency contact:_________________________            Contact number: ___________________

      Employment Status


Job Title:       ____________________________          Work Schedule: ___________________
Immediate Sup: ____________________________            Cost Center:      ___________________
Department Start date: _____________________

      Vacation Request

Half Day:_______          Full Day:________            Start Balance:   ___________ Days

First Day Off:   ___________________________

Last Day Off:    ___________________________           End Balance:     ____________Days

Cancel Vacation_______             First Day Off: ______________        Last Day Off:_____________

     Leave of Absence
General:       _____                    Court Law:         _____        License/ID: _____
Funeral leave: _____                    Birth Day/Adoption: _____       Disability: _____
Critical Surgery: _____
First Day Off:   ___________________________      Last Day Off: _______________________
Reason:          ______________________________________________________________________

Approval
Department Manager:__________________________ Date:____________________________

Human Resources       ___________________________ Date:____________________________