| PART ONE - Employee's Statement | ||
| Employee Name: | ||
| Employee ID#: | ||
| Job Class Title: | ||
| Job Class Number: | ||
| Work Address: | ||
| Full-Time: | Part-Time: | Percent Time: |
| Number of Hours Contributed to the Vacation Donation Program: | ||
| I understand that my contribution is voluntary and non-refundable. I understand that a minimum of eight (8) hours of accrued vacation time is required and that my annual vacation balance will be decreased by the amount contributed. I understand that my contribution is confidential. |
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| Contributing Employee's Signature: |
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| Date: | ||
| PART TWO - Supervisor's Statement | ||
| The above named employee's vacation balance has been reduced by _________ hours of vacation time. I have attached the documents to transfer the salary and fringe benefit dollars to the receiving department. | ||
| Supervisor's Signature: | ||
| Date: | ||
| THE DEPARTMENT ALSO COMPLETES THE CIVIL SERVICE VACATION DONATION WORKSHEET | ||
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