PAID TIME-OFF VOLUNTEER REQUEST FORM

GUIDELINES FOR PAID TIME OFF TO VOLUNTEER

5. Comevo, Inc. will allow an employee to take off up to 5% of their workweek hours to volunteer.  
   
6. An employee must have completed their introductory period before being able to participate in the program.
   
7. An employee needs to submit this completed request to Human Resources and have it approved at least two weeks prior to starting the program.
   
8. An employee’s manager, with agreement from HR, may deny permission to take time off on a temporary or permanent basis due to workload and/or performance reasons.
   
9. An employee can accumulate hours for a one time event by combining multiple weeks’ hours based on the proximity of the volunteer location as follows:
   

3. Up to 20 miles from employee’s residence: 2 weeks
   
4. 21-60 miles from employee’s residence: 3 weeks
   
5. Over 60 miles from employee’s residence: 4 weeks
   

Employee Name:   ____________________________________________________

Hours requested for two-week pay period:  _______________________________

Normal hours worked in a pay period:  __________________________________

Dates and times of volunteer hours:

    Date: _________________________ Time: __________________________

    Date: _________________________ Time: __________________________

    Date: _________________________ Time: __________________________

How often: ___________________________________________________________

Name of Organization:    _____________________________________________

Address:     _______________________________________

        _______________________________________

Distance traveled to Volunteer work: _____________________________________

Organization’s Purpose/Mission:  _____________________________________________________________________

_____________________________________________________________________

Contact person at organization:    _______________________________________

Contact phone number:        _______________________________________

Contact email address:        _______________________________________

Organization EIN:    ______________________________________________________

Please read the following requirements and certify compliance at the bottom

Participating organizations must be: 

3. Recognized by the United States I.R.S. as a 501(c)(3) public charity (excluding the organization types listed in the “Ineligible Organizations” section) or 
   
4. Accredited public or non-profit schools, school districts, colleges, and universities to which contributions are tax deductible under the Internal Revenue Code of the United States (excluding the organization types listed in the “Ineligible Organizations” section). 
   
5. Organizations must confirm compliance with program criteria and participate in the program. 
   

The following are not eligible to participate: 

4. Political organizations (organizations that promote a political party or candidate, or that advocate particular public policy positions). 
   
5. Organizations primarily promoting religious purposes or those requiring participants to be of a certain faith or to participate in programs or receive services. 
   
6. Private foundations, donor advised funds, personal trusts. 
   
7. Organizations that discriminate on the basis of a person's race, color, religion, national origin, sex (including pregnancy), sexual orientation, age, disability, veteran status or other characteristic protected by law. 
   

2. Civic groups that are not exempt under Section 501(c)(3), including fraternal, social, union or veteran organizations.
   
3. Organizations whose philosophy and mission may conflict with Comevo, Inc. policy positions or could potentially cause negative publicity for the company.
    

To the best of my knowledge, I certify that _______________________________ is compliant with the above requirements and that my volunteer hours will occur as stated above. I will immediately update Comevo with any changes to my volunteer work hours. I will report my volunteer work hours on each timesheet as they occur.

Employee  Name:________________________________

Signature:______________________________________          Date: _________________                                                     

Approved by Manager Name: ______________________

Signature:______________________________________          Date: _________________

Approved by Human Resources: ___________________

Signature:______________________________________          Date: _________________