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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.
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* Indicates required question
Email
*
Your email
Full Name (Identical to driver license)
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Gender
*
Female
Male
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
Date of Event
*
MM
/
DD
/
YYYY
Additional Dates 1
MM
/
DD
/
YYYY
Additional Dates 2
MM
/
DD
/
YYYY
Additional Dates 3
MM
/
DD
/
YYYY
City of Event
*
Your answer
Time Event Begins
*
Time
:
AM
PM
Time Event Ends
*
Time
:
AM
PM
Travel From:
*
Your answer
Travel to:
*
Your answer
Date of Departure
*
MM
/
DD
/
YYYY
Time of Departure
*
Time
:
AM
PM
Method of Travel
*
Choose
Flight
Mileage (car)
Amtrak
Car Rental
N/A
Departing Flight Information (Airport, Flight Number, Date, Time)(If none, put N/A)
*
Your answer
Returning Flight Information (Airport, Flight Number, Date, Time)(if none, put N/A)
*
Your answer
Lodging Request
*
Yes
No
If Yes, please explain
Your answer
Medical/Disability needs
*
Yes
No
If Yes, please explain
Your answer
Union Paid Leave Needed
*
Yes
No
Amount of hours requested
Your answer
State Paid Release
*
Yes
No
Amount of hours requested
*
Your answer
Dates Requesting start
*
MM
/
DD
/
YYYY
Dates Requesting end
*
MM
/
DD
/
YYYY
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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