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TO:

VERONICA LORTA, Manager Payroll and Support Services Bureau Employees Name _________________________________________________ Division/Branch/Unit _______________________________________________

FROM:

SUBJECT:

2014 BARGAINING UNIT 7 AND 12 VACATION/ANNUAL LEAVE CASH OUT PROGRAM

I hereby elect to participate/not to participate in the 2014 Bargaining Unit 7 and 12 Vacation/Annual Leave Cash Out Program as described below. I elect not to participate in the 2014 Bargaining Unit 7 and 12 Vacation/Annual Leave Cash Out Program. I elect to participate in the 2014 Bargaining Unit 7 and 12 Vacation/Annual Leave Cash Out Program and certify that I have available leave balances in order to participate in this buy-back program. I elect to cash out the following leave. Vacation Hours: ________ Annual Leave Hours: _______

Total Leave hours elected to cash out (not to exceed 20 hours): _______ I make this election freely and voluntarily and hereby waive any right to change the option selected once processing begins.

Signature of Employee _________________________________ Name (Printed) _________________________________ Classification c: Official Personnel File

Date ________________________ Phone Number ________ CBID