Event Insurance Form by vtm53740

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									                                       State of Missouri
           Department of Insurance, Financial Institutions & Professional Registration
                                     Event Request Form
Complete this form and obtain supervisor's approval prior to event. Attach approved forms to semi-monthly timesheets.

NAME:
SSN:
AGENCY: DIFP-375
ORG:

I hereby request approval as indicated below:

FROM:                                                                       THRU:
                                  (DATE/S)                                                                (DATE/S)

FROM:                                                                       TO:
                                   (TIME)                                                                   (TIME)

                    LEAVE EVENT TYPE                                              LEAVE EVENT DESCRIPTION

                         AL                                                 ANNUAL LEAVE USAGE
                         SLS                                                SICK LEAVE USAGE
                         LWPAA                                              ADMINISTRATIVE LEAVE USAGE - PAID
                         LWPBV                                              BEREAVEMENT - PAID
                         LWPJC                                              JURY/COURT APPEAR - PAID
                         LWPMT                                              15 DAY MI TRAINING - PAID
                         LWPVT                                              VOTING LEAVE - PAID
                         LNP                                                LEAVE WITHOUT PAY - APPROVED
                         LNPWC                                              LEAVE WITHOUT PAY - WORK COMP
                         LNPMD                                              LEAVE WITHOUT PAY - MED DISABILITY

                         ALSHD                                              SHARE LEAVE DONATION

                         OTHER

        DEDICATED EVENT                                        DEDICATED EVENT                                    TIME ESTIMATE
             TYPE                                                DESCRIPTION                                    (INCLUDE TRAVEL)


              MEETINGS
              SEMINARS *
              TRAINING *
              SPECIAL PROJECTS

* In accordance with policy 2.312 defined continuing education programs require the completion and approval of the Continuing
Education Registration Request before enrollment.

                                                     HOLIDAY SUBSTITUTION

              I intend to take the holiday as stated below since the company at which I am working is open on the
                              actual date and since I will be able to take the substitute date at home.

                                 Date of Actual Holiday                      Substitute Date (within 30 days)




                           Employee Signature                                                   Date



                  Supervisor's Signature of Approval                                            Date

								
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