Pay Information And Designation Form Page 2
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1
2Pay Information and Designation Form
Action Required!
Complete all sections of
DURING A CONTINUOUS, APPROVED LEAVE OF ABSENCE
form and return to your
supervisor prior to your
Employee Name: __________________________ Personnel Number: ____________
leave start date.
•
This form is not needed for intermittent leaves of absence or Personal or Educational
Return to PG&E.
Leaves.
•
Vacation and Floating Holidays are not applicable to Hiring Hall employees and are subject to normal department
rules for approval.
•
Foreseeable leaves: Return to your supervisor one-week before your continuous leave of absence begins. If not
foreseeable, return as soon as possible.
•
Designation changes will only be made for urgent and substantial circumstances.
•
You may not use paid time (i.e., sick, vacation, etc.) on an intermittent or reduced schedule basis while you are on a
continuous unpaid leave, including requesting pay in the middle of your leave.
•
The use of paid time runs concurrently with and does not extend your approved time under FMLA/CFRA/CAPDL.
th
•
List your work address on any EDD Disability Insurance forms as 1850 Gateway Blvd., 7
Floor, Concord, CA 94520.
Timely requests for paid or unpaid absences and time entries will reduce the potential for overpayments.
Employees who are overpaid are responsible for reconciliation through the payroll department.
Employee Signature: ______________________________________________
Date: ____/____/_____
Exigency Leave
Estimated First day of Absence: ____/____/_____
When on a leave for a qualifying exigency, you have the option of utilizing your vacation and/or floating holiday pay if
requested in advance and approved through your supervisor.
For Vacation Pay (includes Vacation Buy Days) —needs supervisor approval
Use all available while on leave
OR
Number of Days: ____ or Hours: ____ (confirm available amount with Time Keeper)
For Floating Holidays—needs supervisor approval
Use all available while on leave
OR
Number of Days: ____ or Hours: ____ (confirm available amount with Time Keeper)
ACTION REQUIRED BY SUPERVISOR:
1.
I
approve/
deny the pay request. (check one)
2. First Unpaid date of absence is: ____/____/_____
3. Provide a copy of the form to your timekeeper to ensure appropriate time entries are made.
4. Provide completed form by fax to the PG&E Leave Team at 925-459-6124 or email to .
Supervisor Signature: ___________________________________
Date: ____/____/_____
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