AFSCME Council 57, Local 2620 Travel Authorization Form
This form must be submitted two (2) weeks prior to the event. Please allow 24 to 48 hours for a response.
Email address *
Full Name (Identical to driver license) *
Your answer
Date of Birth *
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DD
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YYYY
Gender *
Work Phone (include area code) *
Your answer
Cell Phone (include area code) *
Your answer
Job Classification *
Your answer
Home Address *
Your answer
Email Address (personal) *
Your answer
Name of Event *
Your answer
Location of Event *
Your answer
Detailed Explanation of Union Purpose for this Event (Include agenda) *
Your answer
Date of Event *
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DD
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YYYY
Address of Event *
Your answer
Time Event Begins *
Time
:
Time Event Ends *
Time
:
Travel From: *
Your answer
Travel to: *
Your answer
Date of Departure *
MM
/
DD
/
YYYY
Time of Departure *
Time
:
Method of Travel *
Departing Flight Information (Airport, Flight Number, Date, Time) *
Your answer
Returning Flight Information (Airport, Flight Number, Date, Time) *
Your answer
Lodging Request *
If Yes, please explain
Your answer
Special Needs *
If Yes, please explain
Your answer
Union Leave Needed *
Number of days requesting
Your answer
Number of hours requesting (ex. 4 hours, 9am - 1pm)
Your answer
Dates Requesting start
MM
/
DD
/
YYYY
Dates Requesting end
MM
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DD
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YYYY
Work Information *
Your answer
Department *
Your answer
Name of Work site and/or facility POC-Region or DOR-Branch *
Your answer
Work Schedule (ex: Mon-Frid) *
Your answer
Work Hours (ex: 8am to 4pm) *
Your answer
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