Request for Secretarial Privilege
Last name	..............................	Position	..............................	Employee №	..............................	
First name	..............................	Department	..............................	Request №	..............................	

To be completed by the secretary requesting the privilege:
Detail the privilege being requested:

Detail the benefit that permitting the privilege would bring to the superior:

Detail the cost that permitting the privilege would incur to the superior:

□  I believe that my conduct warrants the privilege	□  The request is retrospective	

I accept that my superior's decision is final and agree to abide by it without complaint or argument.
..........................................................................................	..............................	.. / .. / ....	
print name	signature	date	

To be completed by the secretary's superior:
□  I permit the privilege, subject to the conditions below	
□  I do NOT permit the privilege, for the reasons below	

Conditions or reasons (optional)

	..............................	.. / .. / ....	
	signature	date