Carlson Building Maintenance
 Per Diem Request   ${date}
   
   
• This form is to be submitted by District Managers only.
• Forms submitted by anyone else will not be processed.
• Fill out all applicable fields highlighted in yellow. Incomplete forms will be returned and reimbursement will be delayed.
• Submit one form per employee. Forms with multiple employees will be returned and reimbursement will be delayed.
• Requests for Per Diem/Mileage will be processed once per week by the Finance Department
• Requests must be submitted by Tuesday at 12:00 PM for the previous calendar week
• Requests received after 12 PM Tuesday will be processed the following week.
• Special notes are required for irregular circumstances
 
employee information
EMPLOYEE NAME ${employeeName}
EMPLOYEE NUMBER ${employeeNum}
DISTRICT MANAGER ${dmUserFirst} ${dmUserLast}
JOB SITE
store location ${location}
city ${city}
state ${state}
hotel
first night needed ${firstNight}
last night needed ${lastNight}
 
per diem FOR OFFICE USE ONLY
ARRIVAL DATE DEPARTURE DATE amt
${arrivalDate} ${departureDate}  
mileage FOR OFFICE USE ONLY
${perDiemInfo}
date departed from destination/store rt/ow mi amt
notes
${comments}
FOR OFFICE USE ONLY
GRAND TOTAL  
REVISED 02/01/2016