Travel outside the continental United States



Travel Outside the Continental United States Company Name FORMTEXT ????? Date: FORMTEXT ?????Contact Name FORMTEXT ?????AddressCity, State, Zip FORMTEXT ?????Prepared By: FORMTEXT ????? FORMTEXT ?????Please fill out form for each trip taken outside of the continental U.S. in a calendar year.1.Please provide the first and last name and title of the employee(s) traveling? FORMTEXT ?????2.What will his/her job duties include while working outside the continental U.S. (please provide details)? FORMTEXT ?????3.How many days, weeks, months and years will employee(s) be working and traveling outside the continental U.S.? Please provide dates of trip. FORMTEXT ?????4.What is the destination? Will employee(s) be going to a U.S. defense base - If so, please identify base FORMTEXT ?????5.How will employee(s) travel? Mark with an “X”.____ Commercial Airline ____ Chartered Aircraft ____ Leased/Rented Aircraft6.If currently covered by Foreign Workers’ Compensation coverage please provide certificate of insurance or copy of declaration page.Other details or comments: FORMTEXT ?????________________________________ ___________ ____________________________Signature/Title DatePrint Name ................
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