Common use of EMPLOYEE REPRESENTATION RELEASE RECORD Clause in Contracts

EMPLOYEE REPRESENTATION RELEASE RECORD. When an agreed upon release time has been approved, the Xxxxxxx shall initiate completion of the form and have the employee, employee's supervisor and Xxxxxxx’x supervisor complete and sign the record after the representation has been completed. The original is to be sent to the Personnel Director, with copies to the Xxxxxxx and his/her supervisor. EMPLOYEE REPRESENTATION RELEASE TIME RECORD Name of Xxxxxxx/Employee Representative ***************************************************************** Employee/Department Requesting Representation: Reason: [ ] Grievance [ ] Discipline Appeal [ ] Meet & Confer Time of Representation: to Employee Signature: Date: ****************************************************************** Employee's Supervisor: Time of Request: Release Time Approved: to Actual Release Time: to Supervisor's Signature: Date: ****************************************************************** Xxxxxxx/Employee Representative Supervisor: Time Request Made: Date: Time Granted: to Actual Time: to Supervisor's Signature: Date: Xxxxxxx/Employee Representative Signature: Date: EXHIBIT I - Flexible Benefits Options Exhibit I – Flexible Benefits Options Option A Core Plan

EMPLOYEE REPRESENTATION RELEASE RECORD. When an agreed upon release time has been approved, the Xxxxxxx shall initiate completion of the form and have the employee, employee's supervisor and Xxxxxxx’x supervisor complete and sign the record after the representation has been completed. The original is to be sent to the Personnel Director, Human Resources Director with copies to the Xxxxxxx and his/her supervisor. EMPLOYEE REPRESENTATION RELEASE TIME RECORD Name of Xxxxxxx/Employee Representative ***************************************************************** Employee/Department Requesting Representation: Reason: [ ] Grievance [ ] Discipline Appeal [ ] Meet & Confer Time of Representation: to Employee Signature: Date: ****************************************************************** Employee's Supervisor: Time of Request: Release Time Approved: to Actual Release Time: to Supervisor's Signature: Date: ****************************************************************** Xxxxxxx/Employee Representative Supervisor: Time Request Made: Date: Time Granted: to Actual Time: to Supervisor's Signature: Date: Xxxxxxx/Employee Representative Signature: Date: EXHIBIT I - Flexible Benefits Options Exhibit I – Flexible -Flexible Benefits Options Option A Butte County Flexible Benefits Options Core Plan

EMPLOYEE REPRESENTATION RELEASE RECORD. When an agreed upon release time has been approved, the Xxxxxxx shall initiate completion of the form and have the employee, employee's supervisor and Xxxxxxx’x supervisor complete and sign the record after the representation has been completed. The original is to be sent to the Personnel Director, with copies to the Xxxxxxx and his/her supervisor. EMPLOYEE REPRESENTATION RELEASE TIME RECORD Name of Xxxxxxx/Employee Representative ***************************************************************** Employee/Department Employee Requesting Representation: Reason: [ ] Grievance [ ] Discipline Appeal [ ] Meet & Confer Time of Representation: to Employee Signature: Date: ****************************************************************** Employee's Supervisor: Time of Request: Release Time Approved: to Actual Release Time: to Supervisor's Signature: Date: ****************************************************************** Xxxxxxx/Employee Representative Supervisor: Time Request Made: Date: Time Granted: to Actual Time: to Supervisor's Signature: Date: Xxxxxxx/Employee Representative Signature: Date: EXHIBIT I - Flexible Benefits Options Exhibit I Attachment C- Grievance Form COUNTY OF BUTTE – Flexible Benefits Options Option HUMAN RESOURCES DEPARTMENT GRIEVANCE FORM Grievance No. (This form to be used by all bargaining units) INFORMAL Step: Immediate Supervisor (informal presentation of grievance to Immediate Supervisor) An informal discussion with the immediate supervisor is required per your MOU. Prior to filing the formal grievance pursuant to Step 1 below, the employee is required to informally discuss the matter with their supervisor to determine if the issue may be resolved. Informal Conference Held Date: Immediate Supervisor title: If the grievance is not settled satisfactorily at the Informal Conference, the grievance may be sent in writing to the Second Level Supervisor to whom the Immediate Supervisor reports within fifteen (15) calendar days of the occurrence or the employee’s knowledge of the occurrence, which gives rise to the grievance. A Core Plangrievance conference will be held within seven (7) days after receipt of a timely grievance at Step 1.

EMPLOYEE REPRESENTATION RELEASE RECORD. When an agreed upon release time has been approved, the Xxxxxxx shall initiate completion of the form and have the employee, employee's supervisor and Xxxxxxx’x supervisor complete and sign the record after the representation has been completed. The original is to be sent to the Personnel Director, with copies to the Xxxxxxx and his/her supervisor. EMPLOYEE REPRESENTATION RELEASE TIME RECORD Name of Xxxxxxx/Employee Representative ***************************************************************** Employee/Department Employee Requesting Representation: Reason: [ ] Grievance [ ] Discipline Appeal [ ] Meet & Confer Time of Representation: to Employee Signature: Date: ****************************************************************** Employee's Supervisor: Time of Request: Release Time Approved: to Actual Release Time: to Supervisor's Signature: Date: ****************************************************************** Xxxxxxx/Employee Representative Supervisor: Time Request Made: Date: Time Granted: to Actual Time: to Supervisor's Signature: Date: Xxxxxxx/Employee Representative Signature: Date: EXHIBIT I - Flexible Benefits Options Exhibit I ATTACHMENT C Grievance Form COUNTY OF BUTTE – Flexible Benefits Options Option HUMAN RESOURCES DEPARTMENT GRIEVANCE FORM Grievance No. (This form to be used by all bargaining units) INFORMAL Step: Immediate Supervisor (informal presentation of grievance to Immediate Supervisor) An informal discussion with the immediate supervisor is required per your MOU. Prior to filing the formal grievance pursuant to Step 1 below, the employee is required to informally discuss the matter with their supervisor to determine if the issue may be resolved. Informal Conference Held Date: Immediate Supervisor title: If the grievance is not settled satisfactorily at the Informal Conference, the grievance may be sent in writing to the Second Level Supervisor to whom the Immediate Supervisor reports within fifteen (15) calendar days of the occurrence or the employee’s knowledge of the occurrence, which gives rise to the grievance. A Core Plangrievance conference will be held within seven (7) days after receipt of a timely grievance at Step 1.

EMPLOYEE REPRESENTATION RELEASE RECORD. When an agreed upon release time has been approved, the Xxxxxxx shall initiate completion of the form and have the employee, employee's supervisor and Xxxxxxx’x supervisor complete and sign the record after the representation has been completed. The original is to be sent to the Personnel Director, with copies to the Xxxxxxx and his/her supervisor. EMPLOYEE REPRESENTATION RELEASE TIME RECORD Name of Xxxxxxx/Employee Representative ***************************************************************** Employee/Department Requesting Representation: Reason: [ ] Grievance [ ] Discipline Appeal [ ] Meet & Confer Time of Representation: to Employee Signature: Date: ****************************************************************** Employee's Supervisor: Time of Request: Release Time Approved: to Actual Release Time: to Supervisor's Signature: Date: ****************************************************************** Xxxxxxx/Employee Representative Supervisor: Time Request Made: Date: Time Granted: to Actual Time: to Supervisor's Signature: Date: Xxxxxxx/Employee Representative Signature: Date: EXHIBIT I - Flexible Benefits Options Exhibit I – Flexible Benefits Options Option A Core PlanAPPENDIX C-Catastrophic Leave Pool Agreement This agreement is entered into between the County of Butte hereinafter referred to as County, and the Butte County Management Employee’s Union, hereinafter referred to as the Union, to implement a Catastrophic Leave Pool for employees in Union. Catastrophic Leave is a leave of absence related to a serious health related condition of a regular employee (or immediate family member) who has exhausted all their own paid leave through a bona fide serious illness or accident. Catastrophic leave does not apply to such conditions as the flu, colds, and/or conditions requiring less than a pay period’s absence or to normal pregnancy. The purpose of the Catastrophic Leave Pool is to enable regular employees in the bargaining unit to receive and donate vacation, administrative leave and compensatory time off (CTO) leave credits to assist employees who have no leave and who will suffer a financial hardship due to prolonged illness or injury to themselves or a member of their immediate family as defined in Personnel Rules. The following conditions shall apply to Catastrophic Leave:

EMPLOYEE REPRESENTATION RELEASE RECORD. When an agreed upon release time has been approved, the Xxxxxxx shall initiate completion of the form and have the employee, employee's supervisor and Xxxxxxx’x supervisor complete and sign the record after the representation has been completed. The original is to be sent to the Personnel Director, with copies to the Xxxxxxx and his/her supervisor. EMPLOYEE REPRESENTATION RELEASE TIME RECORD Name of Xxxxxxx/Employee Representative ***************************************************************** Employee/Department Employee Requesting Representation: Reason: [ ] Grievance [ ] Discipline Appeal [ ] Meet & Confer Time of Representation: to Employee Signature: _ Date: _ ****************************************************************** Employee's Supervisor: Time of Request: Release Time Approved: to Actual Release Time: to Supervisor's Signature: Date: ****************************************************************** Xxxxxxx/Employee Representative Supervisor: Time Request Made: Date: _ Time Granted: to Actual Time: to Supervisor's Signature: Date: Xxxxxxx/Employee Representative Signature: Date: EXHIBIT I - Flexible Benefits Options Exhibit I Attachment C- Grievance Form COUNTY OF BUTTE – Flexible Benefits Options Option HUMAN RESOURCES DEPARTMENT GRIEVANCE FORM Grievance No. (This form to be used by all bargaining units) INFORMAL Step: Immediate Supervisor (informal presentation of grievance to Immediate Supervisor) An informal discussion with the immediate supervisor is required per your MOU. Prior to filing the formal grievance pursuant to Step 1 below, the employee is required to informally discuss the matter with their supervisor to determine if the issue may be resolved. Informal Conference Held Date: Immediate Supervisor title: If the grievance is not settled satisfactorily at the Informal Conference, the grievance may be sent in writing to the Second Level Supervisor to whom the Immediate Supervisor reports within fifteen (15) calendar days of the occurrence or the employee’s knowledge of the occurrence, which gives rise to the grievance. A Core Plangrievance conference will be held within seven (7) days after receipt of a timely grievance at Step 1.

EMPLOYEE REPRESENTATION RELEASE RECORD. When an agreed upon release time has been approved, the Xxxxxxx shall initiate completion of the form and have the employee, employee's supervisor and Xxxxxxx’x supervisor complete and sign the record after the representation has been completed. The original is to be sent to the Personnel Human Resources Director, with copies to the Xxxxxxx and his/her supervisor. EMPLOYEE REPRESENTATION RELEASE TIME RECORD Name of Xxxxxxx/Employee Representative ***************************************************************** Employee/Department Employee Requesting Representation: Reason: [ ] Grievance [ ] Discipline Appeal [ ] Meet & Confer Time of Representation: to Employee Signature: Date: ****************************************************************** Employee's Supervisor: Time of Request: Release Time Approved: to Actual Release Time: to Supervisor's Signature: Date: ****************************************************************** Xxxxxxx/Employee Representative Supervisor: Time Request Made: Date: Time Granted: to Actual Time: to Supervisor's Signature: Date: Xxxxxxx/Employee Representative Signature: Date: EXHIBIT I - Flexible Benefits Options Exhibit I – Butte County Flexible Benefits Options Option A Core PlanEmployee A

EMPLOYEE REPRESENTATION RELEASE RECORD. When an agreed upon release time has been approved, the Xxxxxxx shall initiate completion of the form and have the employee, employee's supervisor and Xxxxxxx’x supervisor complete and sign the record after the representation has been completed. The original is to be sent to the Personnel Human Resources Director, with copies to the Xxxxxxx and his/her supervisor. EMPLOYEE REPRESENTATION RELEASE TIME RECORD Name of Xxxxxxx/Employee Representative ***************************************************************** Employee/Department Employee Requesting Representation: Reason: [ ] Grievance [ ] Discipline Appeal [ ] Meet & Confer Time of Representation: to Employee Signature: Date: _ ****************************************************************** Employee's Supervisor: Time of Request: Release Time Approved: to Actual Release Time: to Supervisor's Signature: Date: ****************************************************************** Xxxxxxx/Employee Representative Supervisor: Time Request Made: Date: _ Time Granted: to Actual Time: to Supervisor's Signature: Date: Xxxxxxx/Employee Representative Signature: _ Date: EXHIBIT I - Exhibit I-Flexible Benefits Benefit Options Exhibit I – Butte County Flexible Benefits Options Option A Core Plan

EMPLOYEE REPRESENTATION RELEASE RECORD. When an agreed upon release time has been approved, the Xxxxxxx shall initiate completion of the form and have the employee, employee's supervisor and Xxxxxxx’x supervisor complete and sign the record after the representation has been completed. The original is to be sent to the Personnel Human Resources Director, with copies to the Xxxxxxx and his/her supervisor. EMPLOYEE REPRESENTATION RELEASE TIME RECORD Name of Xxxxxxx/Employee Representative ***************************************************************** Employee/Department Employee Requesting Representation: Reason: [ ] Grievance [ ] Discipline Appeal [ ] Meet & Confer Time of Representation: to Employee Signature: Date: _ ****************************************************************** Employee's Supervisor: Time of Request: Release Time Approved: to Actual Release Time: to Supervisor's Signature: Date: ****************************************************************** Xxxxxxx/Employee Representative Supervisor: Time Request Made: Date: _ Time Granted: to Actual Time: to Supervisor's Signature: Date: Xxxxxxx/Employee Representative Signature: Date: EXHIBIT I - Exhibit I-Flexible Benefits Benefit Options Exhibit I – Butte County Flexible Benefits Options Option A Core Plan