Volunteer Time Off (Vto) Request Form - Lhp

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Volunteer Time Off (VTO)
Request Form
To be completed by the Volunteering Employee and emailed to Human Resources at
humanresources@lhp.net
Volunteering Employee Information
Employee Name:
Property/Department:
Supervisor:
Charitable Organization Information
Organization Name:
Organization Address:
Organization Contact Name:
Organization Phone:
501(c)(3) tax exempt public charity
Organization is:
Volunteer Time Off Information
Date:
Time:
Total # of Hours:
An Individual
With a group of LHP Employees
I will volunteer as:
Volunteer Activity or Event:
Why is this volunteer experience
important to you?
S
M
L
XL
XXL
XXXL
XXXXL
T-Shirt Size:
White
Blue
Color:
My signature on this document certifies that I understand:
Participation is voluntary;
It is my responsibility to review the LHP Volunteer Time Off Policy;
Any injury resulting from volunteer participation must be immediately reported to the Human Resource
Department.
Employee Signature:
Supervisor Approval:
HR Approval:

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