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City of St. Louis Department of Personnel Administrative Regulation NO. 148 BeeFit Request Form |
The City of St. Louis Administrative Regulations have been converted to electronic format by the staff of the St. Louis Public Library. This electronic version has been done for the interest and convenience of the user. These are unofficial versions and should be used as unofficial copies.
Official printed copies of the City of St. Louis Administrative Regulations may be obtained from the Personnel Office at 1114 Market Street, Room 703, St. Louis, Missouri 63101.
BEEFIT WELLNESS PROGRAM REQUEST
|
____________________________________ NAME (Print) |
_______________________ DEPARTMENT |
TYPE/NAME OF PROGRAM: _________________________________________________
(Refer to Administrative Regulation No. 148 )
| SCHEDULED PARTICIPATION: |
____________________ Day(s) |
____________________ Time(s) |
Employee: I hereby request permission to participate in the above program. I understand that this permission may be rescinded at any time by the appointing authority or his/her designee. The maximum number of hours per week is three (3) hours.
|
____________________________________ Signature of Employee |
_______________________ Date |
____ APPROVED
____ DISAPPROVED
| ______________________________ Name and Title of Appointing Authority |
___________________ Signature |
__________ Date |
(PREPARE THIS FORM IN TRIPLICATE)
Distribution: Original- Department of Personnel, Employee Benefits, 2nd copy - Originating Department, 3rd copy- Employee
09/08
Back to Administrative Regulation NO. 148
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