Leave Authorization/payroll Deduction Agreement
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1LEAVE AUTHORIZATION/PAYROLL DEDUCTION AGREEMENT
University of North Dakota
Employee Name:
Employees Department:
Position/title:
I request approval to take
hours of sick leave and/or
hours of annual leave
on these dates:
.
My leave balances are
hours sick leave and
hours annual leave.
Accordingly, approval to take leave in advance of accumulation is required. I understand
such approval is at the discretion of the department head, with approval of the appropriate
institution or agency officer. I also understand that any leave taken in advance of
accumulation must be paid back if employment is terminated before I have accumulated
enough leave to make up any negative leave balance. As a condition of approval to take
leave in advance of accumulation, I request and authorize a deduction from my final
paycheck in the amount of $
(value of approved leave in advance) or such
lesser amount required to pay off the balance of any unearned leave taken that remains on
the date employment is terminated.
Date:
Employee
Approved:
Date:
Department head
Date:
Director of Human Resources
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Parent category: Business