Unlv Faculty/professional Staff Declaration Of Unpaid Leave/workload Adjustment Form

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UNLV Faculty/Professional Staff Declaration of Unpaid Leave/Workload Adjustment
Employee Name (please print)______________________ Position Title ___________________________
Department/College __________________________
Employee # ___________ Date ____________
Part I.
VOLUNTARY – Completion of this part of the form is NOT REQUIRED
Actions Towards
Strictly Voluntary
1.
I will take ________ unpaid days in FY10- THESE WILL NOT count towards
Measures (does not
FY11 mandatory days (savings go to Department budget – maximum of 12
count towards FY11
days/4.6% of salary allowed).
mandatory actions):
2.
I will make a contribution to the UNLV Foundation (scholarship or other
appropriately designated): Refer to UNLV form & process for payroll deduction
(CTRL + click the following link):
Submit directly to UNLV Foundation
3.
Check here for none of the
above.
Part II.
MANDATORY- Completion of the part of the form IS REQUIRED
Actions Towards
FY11 Mandatory
1. Voluntary unpaid days in FY10 to count towards FY11 mandatory days:
_______
Measures –
All
(savings taken centrally).
(unpaid leave days are not refundable)
Professional and
Administrative Staff
2. Unpaid days in FY11 to count towards FY11 mandatory days:
_______
(includes VPs, Deans,
(savings taken centrally).
FIR’s, and tenure-
Total must add to 12 For F/T 12-month staff , 8.3 for “B” contracts
TOTAL: _______
track but not yet
(Note: Consult Supervisor to determine number of days for less than F/T)
tenured faculty):
Actions Towards
1. I acknowledge that a Dept/College proportional workload increase will be required :
FY11 Mandatory
________ (employee initials)
Measures –
Tenured
Instructional Faculty
-----OR, as a Voluntary Alternative to a Workload Adjustment -----
Only
-does not
include VPs, Deans,
1. Voluntary unpaid days in FY10 to count towards FY11 mandatory days:
etc.
(savings taken centrally).
(unpaid leave days are not refundable)
_______
Department Chairs
2. Unpaid days in FY11 to count towards FY11 mandatory days:
and Associate Deans
(savings taken centrally).
______
follow a “hybrid”
model and must
Total must add to 12 For F/T 12-month staff , 8.3 for “B” contracts
TOTAL: _______
complete a different
And 11 for “B-11” contracts
form designed for
(Note: Consult Supervisor to determine number of days for less than F/T)
their
options:
Employee Signature: ____________________________________________
Date: ________________
Supervisor Approval: ____________________________________________
Date: ________________
(Note: This proposal is not approved until signed by the appropriate supervisor)

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