Common use of Reason for Leave Clause in Contracts

Reason for Leave. I request Catastrophic Leave for the following reason and will attach appropriate documentation to support my request.  My own long-term catastrophic illness or injury  The long-term catastrophic illness or injury of my spouse, domestic partner, child, or parent Name of individual(s) Relationship  Other (please fully specify) EXPECTED DURATION (Include doctor’s certification and documentation explaining the medical situation.)  A block of time from to (Month/Day/Year) (Month/Day/Year)  Intermittently e.g., separate blocks of time due to illness.  Temporarily reduced work schedule. Employee Signature Date Distribution with all documentation to: Employee’s Department Head Original to Human Resources Department at: 000 Xxx Xxx Xxxx Xxxxx, XX 00000 TO BE COMPLETED BY HUMAN RESOURCES Eligible: Y N Initials: Date: Donation to Union Release Bank ‌ Name: SS#: Department: Work Phone: This is my authorization to credit the Union Release Time Bank with leave time from my accruals. Please deduct the time from the type(s) of leave indicated below, in the indicated time increments. Please donate in whole hours or 15-minute increments. Vacation:  15 Min.  One Hour  Eight Hours  Other: Hr Min CTO:  15 Min.  One Hour  Eight Hours  Other: Hr Min Personal Leave: 15 Min.  One Hour  Eight Hours  Other: Hr Min Signature: Date:  This Pay Period only.  Each Pay Period beginning Pay Period .  Employee’s Copy  Union’s Copy  Human Resource’s Copy  Payroll’s Copy Donation to Union Release Bank Name: SS#: Department: Work Phone: This is my authorization to credit the Union Release Time Bank with leave time from my accruals. Please deduct the time from the type(s) of leave indicated below, in the indicated time increments. Please donate in whole hours or 15-minute increments. Vacation:  15 Min.  One Hour  Eight Hours  Other: Hr Min CTO:  15 Min.  One Hour  Eight Hours  Other: Hr Min Personal Leave: 15 Min.  One Hour  Eight Hours  Other: Hr Min Signature: Date:  This Pay Period only.  Each Pay Period beginning Pay Period .  Employee’s Copy  Union’s Copy  Human Resource’s Copy  Payroll’s Copy

Reason for Leave. I request Catastrophic Leave for the following reason and will attach appropriate documentation to support my request.  ❑ My own long-term catastrophic illness or injury  ❑ The long-term catastrophic illness or injury of my spouse, domestic partner, child, or parent Name of individual(s) Relationship  ❑ Other (please fully specify) EXPECTED DURATION (Include doctor’s certification and documentation explaining the medical situation.)  ❑ A block of time from to (Month/Day/Year) (Month/Day/Year)  ❑ Intermittently e.g., separate blocks of time due to illness.  ❑ Temporarily reduced work schedule. Employee Signature Date Distribution with all documentation to: Employee’s Department Head Original to Human Resources Department at: 000 Xxx Xxx Xxxx Xxxxx, XX 00000 TO BE COMPLETED BY HUMAN RESOURCES Eligible: Y N Initials: Date: Donation to Union Release Bank ‌ Name: SS#: Department: Work Phone: This is my authorization to credit the Union Release Time Bank with leave time from my accruals. Please deduct the time from the type(s) of leave indicated below, in the indicated time increments. Please donate in whole hours or 15-minute increments. Vacation:  ❑ 15 Min.  ❑ One Hour  ❑ Eight Hours  ❑ Other: Hr Min CTO:  ❑ 15 Min.  ❑ One Hour  ❑ Eight Hours  ❑ Other: Hr Min Personal Leave: Leave:❑ 15 Min.  ❑ One Hour  ❑ Eight Hours  ❑ Other: Hr Min Signature: Date:  ❑ This Pay Period only.  ❑ Each Pay Period beginning Pay Period .  ❑ Employee’s Copy  ❑ Union’s Copy  ❑ Human Resource’s Copy  ❑ Payroll’s Copy Donation to Union Release Bank Name: SS#: Department: Work Phone: This is my authorization to credit the Union Release Time Bank with leave time from my accruals. Please deduct the time from the type(s) of leave indicated below, in the indicated time increments. Please donate in whole hours or 15-minute increments. Vacation:  ❑ 15 Min.  ❑ One Hour  ❑ Eight Hours  ❑ Other: Hr Min CTO:  ❑ 15 Min.  ❑ One Hour  ❑ Eight Hours  ❑ Other: Hr Min Personal Leave: Leave:❑ 15 Min.  ❑ One Hour  ❑ Eight Hours  ❑ Other: Hr Min Signature: Date:  ❑ This Pay Period only.  ❑ Each Pay Period beginning Pay Period .  ❑ Employee’s Copy  ❑ Union’s Copy  ❑ Human Resource’s Copy  ❑ Payroll’s Copy

Reason for Leave. I request Catastrophic Leave for the following reason and will attach appropriate documentation to support my request.  My own long-term catastrophic illness or injury  The long-term catastrophic illness or injury of my spouse, domestic partner, child, or parent Name of individual(s) Relationship  Other (please fully specify) EXPECTED DURATION (Include doctor’s certification and documentation explaining the medical situation.)  A block of time from to (Month/Day/Year) (Month/Day/Year)  Intermittently e.g., separate blocks of time due to illness.  Temporarily reduced work schedule. Employee Signature Date Distribution with all documentation to: Employee’s Department Head Original to Human Resources Department at: 000 Xxx Xxx Xxxx Xxxxx, XX 00000 TO BE COMPLETED BY HUMAN RESOURCES Eligible: Y N Initials: Date: Donation to Union Release Bank ‌ Name: SS#: Department: Work Phone: This is my authorization to credit the Union Release Time Bank with leave time from my accruals. Please deduct the time from the type(s) of leave indicated below, in the indicated time increments. Please donate in whole hours or 15-minute increments. Vacation:  15 Min.  One Hour  Eight Hours  Other: Hr Min CTO:  15 Min.  One Hour  Eight Hours  Other: Hr Min Personal Leave: 15 Min.  One Hour  Eight Hours  Other: Hr Min Signature: Date:  This Pay Period only.  Each Pay Period beginning Pay Period .  Employee’s Copy  Union’s Copy  Human Resource’s Copy  Payroll’s Copy Donation to Union Release Bank Name: SS#: Department: Work Phone: This is my authorization to credit the Union Release Time Bank with leave time from my accruals. Please deduct the time from the type(s) of leave indicated below, in the indicated time increments. Please donate in whole hours or 15-minute increments. Vacation:  15 Min.  One Hour  Eight Hours  Other: Hr Min CTO:  15 Min.  One Hour  Eight Hours  Other: Hr Min Personal Leave: 15 Min.  One Hour  Eight Hours  Other: Hr Min Signature: Date:  This Pay Period only.  Each Pay Period beginning Pay Period .  Employee’s Copy  Union’s Copy  Human Resource’s Copy  Payroll’s Copy.

Reason for Leave. I request Catastrophic Leave for the following reason and will attach appropriate documentation to support my request.  ❑ My own long-term catastrophic illness or injury  ❑ The long-term catastrophic illness or injury of my spouse, domestic partner, child, or parent Name of individual(s) Relationship  ❑ Other (please fully specify) EXPECTED DURATION (Include doctor’s certification and documentation explaining the medical situation.)  ❑ A block of time from to (Month/Day/Year) (Month/Day/Year)  ❑ Intermittently e.g., separate blocks of time due to illness.  ❑ Temporarily reduced work schedule. Employee Signature Date Distribution with all documentation to: Employee’s Department Head Original to Human Resources Department at: 000 Xxx Xxx Xxxx Xxxxx, XX 00000 TO BE COMPLETED BY HUMAN RESOURCES Eligible: Y N Initials: Date: Donation to Union Release Bank ‌ Name: SS#: Department: Work Phone: This is my authorization to credit the Union Release Time Bank with leave time from my accruals. Please deduct the time from the type(s) of leave indicated below, in the indicated time increments. Please donate in whole hours or 15-minute increments. Vacation:  ❑ 15 Min.  ❑ One Hour  ❑ Eight Hours  ❑ Other: Hr Min CTO:  ❑ 15 Min.  ❑ One Hour  ❑ Eight Hours  ❑ Other: Hr Min Personal Leave: Leave:❑ 15 Min.  ❑ One Hour  ❑ Eight Hours  ❑ Other: Hr Min Signature: Date:  ❑ This Pay Period only.  ❑ Each Pay Period beginning Pay Period .  ❑ Employee’s Copy  ❑ Union’s Copy  ❑ Human Resource’s Copy  ❑ Payroll’s Copy Donation to Union Release Bank Name: SS#: Department: Work Phone: This is my authorization to credit the Union Release Time Bank with leave time from my accruals. Please deduct the time from the type(s) of leave indicated below, in the indicated time increments. Please donate in whole hours or 15-minute increments. Vacation:  ❑ 15 Min.  ❑ One Hour  ❑ Eight Hours  ❑ Other: Hr Min CTO:  ❑ 15 Min.  ❑ One Hour  ❑ Eight Hours  ❑ Other: Hr Min Personal Leave: Leave:❑ 15 Min.  ❑ One Hour  ❑ Eight Hours  ❑ Other: Hr Min Signature: Date:  ❑ This Pay Period only.  ❑ Each Pay Period beginning Pay Period .  ❑ Employee’s Copy  ❑ Union’s Copy  ❑ Human Resource’s Copy  ❑ Payroll’s CopyCopy MEMORANDUM OF UNDERSTANDING