Associate Action Notice

Associate Name*
First Last
Associate Number*
PLEASE NOTE: This is the JIC 5-digit associate number provided at time of employment, not the Ceridian badge number. This number can be found under the name on the JIC issued badge (Emp #: nnnnn). If the number is only 4 digits, enter a leading zero.
Department*
Other Department*
Shift*
Notice Type*
Request Date*
MM slash DD slash YYYY
Request From Date*
MM slash DD slash YYYY
Request To Date*
MM slash DD slash YYYY
Hours*
Hours*
Shift Start / End*
Select when the 2 or 4 hour request will be taken.
- Start of Shift
- End of Shift
Relationship*
Special Comments / Instructions
Request a copy
- I would like an email copy for my records
Email Address*
Acknowledgment*
I understand that this Associate Action Notice is a request only and proper approval(s) are necessary and that I will receive notification of the final decision.
I understand the approval process.
Are you a robot?
Phone
This field is for validation purposes and should be left unchanged.