Extension - DO NOT SUBMIT
Extension Agreement:
Template Please Complete
Hospital Memorial Hospital Belleville
Traveler Name Tad Finch
Specialty / Unit R&B ICU, (phone number removed)
Current end date 2/28
Any Requested Time Off (between contract or during): 3/24, 3/28, 3/29, 4/3, 4/11, 4/23, 4/28, 5/17, 5/24, 5/26, 6/23
Proposed extension dates (start): 3/1
Proposed extension dates (end): 5/30 (13 weeks)