ࡱ> kmj!`  bjbj\\ U>>]"""8"$" D2#:$:$:$:$&vf'D'$DDDDDDD$EhH*D9+&&@9+9+*D:$:$r?D,,,9+@:$:$D,9+D,,>t@:$# ('#"y+P?AUD0Dd?H+H(t@Ht@'R(^,(L(='''*D*Dq,'''D9+9+9+9+    Absence Request Absence InformationEmployee Name:Employee Number:Department:Type of Absence Requested: FORMCHECKBOX Sick FORMCHECKBOX Vacation FORMCHECKBOX Bereavement FORMCHECKBOX Time Off Without Pay FORMCHECKBOX Military FORMCHECKBOX Jury Duty FORMCHECKBOX Maternity/Paternity FORMCHECKBOX OtherDates of Absence: From:To: From:   To:  From:   To: Reason for Absence:You must submit requests for absences, other than sick leave, two weeks prior to the first day you will be absent. Employee SignatureDateManager Approval FORMCHECKBOX Approved FORMCHECKBOX Coverage FORMCHECKBOX Employee Calendar FORMCHECKBOX Rejected FORMCHECKBOX Medent FORMCHECKBOX Physician CopyComments:Manager SignatureDate     Digestive Disease and Nutrition Center of Westchester, LLP.  Jack Rosemarin, M.D., F.A.C.G. Two Gannett Drive Alfred D. Roston, M.D., F.A.C.G. White Plains, New York 10604 Charles M. Noyer, M.D., F.A.C.P. 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CORPORATE%20SIGNuS`TuS`T"`HB  C DHI_L~L,~u~<@Check3Check4Check1Check5Check6Check7Check2Check8u %K5[ $l&E %l'E &dQ: 'Q: (Q: )$R: *dR: +R: ,R: ""09.8>>>*urn:schemas-microsoft-com:office:smarttags PostalCode9*urn:schemas-microsoft-com:office:smarttagsState8*urn:schemas-microsoft-com:office:smarttagsCity:*urn:schemas-microsoft-com:office:smarttagsStreet;*urn:schemas-microsoft-com:office:smarttagsaddress=*urn:schemas-microsoft-com:office:smarttags PlaceType= *urn:schemas-microsoft-com:office:smarttags PlaceName9*urn:schemas-microsoft-com:office:smarttagsplace 8< t$6J\y07I?a*,90eEpvUxyZwΥ{rjy@&R88^8`OJPJQJo(-^`OJQJ^Jo(o  ^ `OJQJ^Jo(  ^ `OJQJ^Jo(xx^x`OJQJ^Jo(oHH^H`OJQJ^Jo(^`OJQJ^Jo(^`OJQJ^Jo(o^`OJQJ^Jo(88^8`OJPJQJo(-^`OJQJ^Jo(o  ^ `OJQJ^Jo(  ^ `OJQJ^Jo(xx^x`OJQJ^Jo(oHH^H`OJQJ^Jo(^`OJQJ^Jo(^`OJQJ^Jo(o^`OJQJ^Jo(88^8`OJPJQJo(-^`OJQJ^Jo(o  ^ `OJQJ^Jo(  ^ `OJQJ^Jo(xx^x`OJQJ^Jo(oHH^H`OJQJ^Jo(^`OJQJ^Jo(^`OJQJ^Jo(o^`OJQJ^Jo( 88^8`OJPJQJo(-^`OJQJ^Jo(o  ^ `OJQJ^Jo(  ^ `OJQJ^Jo(xx^x`OJQJ^Jo(oHH^H`OJQJ^Jo(^`OJQJ^Jo(^`OJQJ^Jo(o^`OJQJ^Jo(88^8`OJPJQJo(-^`OJQJ^Jo(o  ^ `OJQJ^Jo(  ^ `OJQJ^Jo(xx^x`OJQJ^Jo(oHH^H`OJQJ^Jo(^`OJQJ^Jo(^`OJQJ^Jo(o^`OJQJ^Jo(88^8`OJPJQJo(-^`OJQJ^Jo(o  ^ `OJQJ^Jo(  ^ `OJQJ^Jo(xx^x`OJQJ^Jo(oHH^H`OJQJ^Jo(^`OJQJ^Jo(^`OJQJ^Jo(o^`OJQJ^Jo(88^8`OJPJQJo(-^`OJQJ^Jo(o  ^ `OJQJ^Jo(  ^ `OJQJ^Jo(xx^x`OJQJ^Jo(oHH^H`OJQJ^Jo(^`OJQJ^Jo(^`OJQJ^Jo(o^`OJQJ^Jo(0eEyZ*{rjyvUV=        Ϯ        @Xr        o        $I        Q8A                #"(#91R, .)R*[*m-C.5p/j_Fz/c'`kXtSv Xv.aUBDZM<=;E`?_]eo %&567HIUVWrst$6J\bc|}uvwxy07IXYcdefghi|@  <`@UnknownGz Times New Roman5Symbol3& z Arial?5 z Courier New;Wingdings"qh╬&㕬&ITs&!~4 3qHP)?.2Absence RequestRichard RosemarinRichard Rosemarin(       Oh+'0 $0 P \ h tAbsence RequestRichard RosemarinNormalRichard Rosemarin1Microsoft Office Word@F#@Q@,R&#@r '#՜.+,0  hp  Rosemarin & Roston, LLP Absence Request Title  !"#$%&'()*,-./012346789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXY[\]^_`acdefghilRoot Entry FL('#nData +t1Table5HWordDocumentUSummaryInformation(ZDocumentSummaryInformation8bCompObjq  FMicrosoft Office Word Document MSWordDocWord.Document.89q