REQUEST FOR VOLUNTARY FURLOUGH PROGRAM Name_________________________________ Date:__________________ Title__________________________________ Z#____________________ I have read and understand the procedures and requirements for participation in the Voluntary Furlough Program ____________________________________ Signature/Date Option 1: Reduced Hours Per Workday Reduction in hours worked per day may only be requested at the start or end of a work shift. ___ Work hours per day reduced for the following dates as specified: Option 2: Reduced Days Per Pay Period ___ Workdays per pay period reduced for the following dates as specified: Option 3: Reduced Weeks Per Year ___ Workweeks per year reduced for the following dates as specified: Recommendations and Approval Budget Unit Manager __________________________________ Yes No Divisional Vice President _______________________________ Yes No Appointing Authority __________________________________ Yes No Human Resources/Payroll Use Only Position # ____________ Budget Unit _____________________________________ __ Human Resources __ Working Test Period __ Payroll __ Pension Interruption __ PMIS Actions __ Health Benefits co-payment Due Approval Copy: Payroll Budget Unit Manager Divisional Vice President Employee File (original)
REQUEST FOR VOLUNTARY FURLOUGH PROGRAM Name_________________________________ Date:__________________ Title__________________________________ Z#____________________ I have read and understand the procedures and requirements for participation in the Voluntary Furlough Program ____________________________________ Signature/Date Option 1: Reduced Hours Per Workday Reduction in hours worked per day may only be requested at the start or end of a work shift. ___ Work hours per day reduced for the following dates as specified: Option 2: Reduced Days Per Pay Period ___ Workdays per pay period reduced for the following dates as specified: Option 3: Reduced Weeks Per Year ___ Workweeks per year reduced for the following dates as specified: Recommendations and Approval Budget Unit Manager __________________________________ Yes No Divisional Vice President _______________________________ Yes No Appointing Authority __________________________________ Yes No Human Resources/Payroll Use Only Position # ____________ Budget Unit _____________________________________ __ Human Resources __ Working Test Period __ Payroll __ Pension Interruption __ PMIS Actions __ Health Benefits co-payment Due Approval Copy: Payroll Budget Unit Manager Divisional Vice President Employee File (original)
furlough_form2014.docx