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) *
Date of Birth *
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Gender *
Work Phone (include area code) *
Cell Phone (include area code) *
Job Classification *
Home Address *
Email Address (personal) *
Name of Event *
Date of Event *
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City of Event *
Time Event Begins *
Time
:
Time Event Ends *
Time
:
Travel From: *
Travel to: *
Date of Departure *
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Time of Departure *
Time
:
Method of Travel *
Departing Flight Information (Airport, Flight Number, Date, Time)(If none, put N/A) *
Returning Flight Information (Airport, Flight Number, Date, Time)(if none, put N/A) *
Lodging Request *
If Yes, please explain
Medical/Disability needs *
If Yes, please explain
Union Paid Leave Needed *
Amount of hours requested
State Paid Release *
Amount of hours requested *
Dates Requesting start
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Dates Requesting end
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Department *
Name of Work site and/or facility POC-Region or DOR-Branch *
Work Schedule (ex: Mon-Frid) *
Work Hours (ex: 8am to 4pm) *
Submit
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