F-393

(Revised 5/07)

Central Freight Lines, Inc.

Salaried Employee Request for Time Off

(excluding Leave of Absence Requests)

(Please Print or Type)

Employee Name: SS#:
Location & Department: ID#:
Date of Request:

Reason for Request: Vacation * * * Funeral Jury

I am requesting time off from and continuing through

(type or print Month, Day, Year)

, The total number of days being requested is/are .

(type or print Month, Day, Year)

I will return to work on ,

(type or print Month, Day, Year)

Employee Signature: Date:

______

(To be completed by Manager)

Request for Time Off: Approved Disapproved

Manager Signature: Date:

______

*** Vacation Payment Only ***

Authorized for payment: Manager Initials Date:

Send your request to the Payroll Department before the Friday of the Pay Period End in which the Vacation Time was taken. Payroll# 254-741-5256 / Fax# 254-741-5335