Classified Mandatory Unpaid Furlough Leave Request Form

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UNLV
Classified Mandatory Unpaid Furlough Leave Request Form
January 1, 2014 through June 30, 2014
Name:
Employee ID:
Department:
Please designate your first choice of days for furlough for the next six months. If your designations cannot be
approved, your supervisor will assign an unpaid furlough leave schedule. Please note you must take a total of
48 hours furlough for the fiscal year July 1, 2013 through June 30, 2014 (part-time prorated). Also, please note
that you may not schedule more than 12 furlough hours in any single work week (Sunday through Saturday)
and overtime in the same work week that furlough occurs is not permitted.
HRMS
Pay Period
Date/Hours
*Date/Hours
*Date/Hours
*Date/Hours
Total
Hours
Cycle
st
th
012
January 1
-15
/
/
/
/
th
st
021
January 16
-31
/
/
/
/
st
th
022
February 1
-15
/
/
/
/
th
th
031
February 16
-28
/
/
/
/
st
th
032
March 1
-15
/
/
/
/
th
st
041
March 16
-31
/
/
/
/
st
th
042
April 1
-15
/
/
/
/
th
th
051
April 16
-30
/
/
/
/
st
th
052
May 1
-15
/
/
/
/
th
st
061
May 16
-31
/
/
/
/
st
th
062
June 1
-15
/
/
/
/
th
th
071
June 16
-30
/
/
/
/
Total Hours
*To be used if splitting furlough leave between different days for a given pay period.
Part time or employees on variable schedule please attach a copy of your schedule.
Changes made after this form is approved may only be made within the pay period for which the original
permitted designation occurred, and must be approved by your supervisor.
I acknowledge that unpaid furlough leave will be taken out of my paychecks for each period approved over the
next six months. These periods of unpaid furlough leave were mandated by SB 505.
Employee’s Signature: ________________________________________
Date ______________
Supervisor’s Signature: _______________________________________
Date: _____________
Notes
Original-Leave Record
Copy- Employee, Supervisor
Changes to furlough schedule are to be managed within the same pay period and documented on this form to
be retained in the Department in the leave record.

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