Fillable Banked Leave Application - BANKED LEAVE.0908.Rev

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Banked Leave Application - BANKED LEAVE.0908.Rev

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File type: PDF

U.S.A. forms for Mission College

BROWSE MISSION COLLEGE FORMS

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Distribution:Original:VicePresident 1
st
Copy:DeptChair 2
nd
Copy:Applicant 3
rd
Copy:HR 4
th
Copy‐Payroll
WESTVALLEY–MISSIONCOMMUNITYCOLLEGEDISTRICT
APPLICATIONFORBANKEDLEAVE
CurrentBalance: _______________
WVC Pre‐Retirement(includeplan)____________

EmployeeInitial: _______________
MC LoadAdjustment____________

If you are requesting multiple semesters / academic years, please submit one form for each request.
PartialSemester FullSemester
PreviousSemesterLeaveTaken?YesNo PreviousSemesterLeaveTaken?YesNo
Ifyes,when?_____________ Ifyes,when?_____________
Bankedloadrequested:RegularPre‐retirement Bankedloadrequested:RegularPre‐retirement
_______%for_____________Semesterduring _______%for_____________Semesterduring
_____________Academicyear. _____________Academicyear.
A. APPLICANTTOCOMPLETE

NameDepartment Division
Comments:
________________________________________________________________________________________________________
________________________________________________________________________________________________________
Applicant’sSignature:____________________________________ Date:______________
B. RECOMMENDATIONS
(Toensureapplicationisprocessedinatimelymanner,theapplicantis
encouragedtoobtainappropriatesignatures.)
1. DepartmentChair/AppropriateSupervisoryAdministrator
ApprovedNotApproved
(Notifythememberinwriting.)
ProgramImpact
ProposedAlternativeCoverage
CurrentStatusofAssociatePool
Signature:__________________________________________________ Date:______________
2. DivisionChair
ApprovedNotApproved
(Notifythememberinwriting.)
Signature–DivisionChair:____________________________________ Date:______________
3. AppropriateV.P.(Completedbythedeadlineinthesemesterpriortosemesterofleave.)
ApprovedNotApproved
(Notifythememberinwriting.)
Signature–VicePresident:____________________________________ Date:______________
Applicationreview/approvalprocessmustbecompletedbythe3rd Fridayin thesemesterpriortosemesterofleave.
ForHRUseOnly:
Disc Coun cil Date:____________LogDate:____________Rec’dinHR:____________Rec’dby:____________MonthlyRate:$__________
Revised:HR/bb/1-13-12
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Banked Leave Application - BANKED LEAVE.0908.Rev

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Completed 9 March 2020

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