Unpaid Vacation Time Request printable pdf download

Unpaid Vacation Time Request

Calvin employees have the opportunity, with supervisor approval, to take an extra week or two of

unpaid time off each year. The cost of this would be approximately two percent of one's salary per

additional week of unpaid time off. In addition, benefits based on annual salary (pension

contributions, life insurance, and long term disability) will also be adjusted. This adjustment can be a

permanent feature of employment or renewed on an annual basis. Forms should be completed and

returned to Human Resources.

For salaried (exempt) employees:

With supervisor approval the unpaid time may be taken at any time during the academic year

(September through August). If the request form is returned to Human Resources by August 15, the

salary reduction will be spread over the academic year with a portion of the money deducted from each

pay period. Salary reductions for requests made later than August 15 will be spread over the remaining

paychecks for that academic year.

For hourly (non-exempt) employees:

With supervisor approval the unpaid time may be taken at any time during the academic year

(September through August). Hourly employees are paid for hours worked so any unpaid time would

be reflected during the pay period in which the unpaid time is taken. Completion of this form is still

mandatory.

Once processed, you will receive a copy of this form for your records.

Name ______________________________ ID # ______________________

Amount of unpaid time requested for the _______ - _______ academic year:

Salaried

________ 1 week

________ 2 weeks

Hourly

Number of days _________ (up to 10)

Is this a permanent change?

Yes / No

Employee Signature_____________________________________ Date_________

Supervisor Signature_____________________________________Date_________

Vice President Signature__________________________________Date_________

For HR Office Use:

Date form received: _______________________

Current Salary: _______________

New Salary: __________________

HR Signature _______________________________ Date______________

_____ WAGS

_____ PPOS _____ ESHN _____ DISC _____ GLIF _____ Copy to payroll _____ Copy to Employee

Unpaid Vacation Time Request