For UNLV Tenured Department Chairs and Associate Deans ONLY
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
1.
I will take ________ unpaid days in FY10- THESE WILL NOT count towards
Strictly Voluntary
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
1. I acknowledge that a Dept/College proportional workload increase will be required
FY11 Mandatory
for the “B” base portion of my contract : ________ (employee initials)
Measures –
Tenured
-- AND, for the Annual Salary Amount over the “B” Base Contract I will be required to
Department Chairs
have an unpaid leave reduction --
and Associate Deans
ONLY.
2. Unpaid days in FY11 to count towards FY11 mandatory days:
______
(savings taken centrally and subject to individual calculation based
on 20% increase over “B” base and stipend amount only).
--OR—
--- As a Voluntary Alternative to a Workload Adjustment AND Unpaid Leave
Requirement ---
1. Voluntary unpaid days in FY10 to count towards FY11 mandatory days:
(savings taken centrally).
(unpaid leave days are not refundable)
_______
2. Unpaid days in FY11 to count towards FY11 mandatory days:
(savings taken centrally).
______
Total must add to 12 For F/T 12-month staff , 8.3 for “B” contracts
TOTAL: _______
And 11 for “B-11” contracts
(Note: Consult Supervisor to determine number of days for less than F/T)
Employee Signature: ____________________________________________
Date: ________________
Supervisor Approval: ____________________________________________
Date: ________________
(Note: This proposal is not approved until signed by the appropriate supervisor)
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