Time-Off Request Employee* Select NameAmy BocheChris GrecoDi EvensonJackie AmacciJamie NelsonJenna BeckerJoleen MunsonKari ManganKarina Henriksen-MundoKatie TraugerKristin KellyLindsey ThompsonLisa HarterMichelle SchunemanSkyler SherrettSue EtienneTracy BehrValerie Crotty Email* Start Date* Date Format: MM slash DD slash YYYY End Date* Date Format: MM slash DD slash YYYY Start Time* : HH MM AMPM TIME YOU WILL BE LEAVING OR IF FOR THE DAY PUT 8AM. End Time* : HH MM AMPM TIME YOU WILL RETURN OR IF FOR THE DAY PUT 5PM. How would you like to take this time off?* PTOBlue DotsGold CoinsNo LunchPartial LunchNo PayFuneralOther # of Hours Requested* Will you be taking lunch?* Yes No Comments: E-Signature Your Electronic Signature is valid for Paid Time-Off Requests Only. E-Signature* I Acknowledge and Agree to the Terms & Conditions of the Paid Time-Off Agreement I understand and agree that Blue Ribbon has agreed to advance me personal time-off, which I will be paid for and currently may not have accrued, for the time period requested on this form. I further understand and agree that I must reimburse Blue Ribbon for the personal time-off I have been paid for, but not yet earned, by either deducting paid time-off that I accrue or, in the event that my employment relationship with Blue Ribbon is terminated, for any reason, prior to my accruing the requisite paid time-off for reimbursement, I authorize Blue Ribbon to deduct any and all remaining unreimbursed paid time-off from my final payroll payment.