Fillable Form HR-106: EMERGENCY PREPAREDNESS CASH OUT FORM (Syracuse City)

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Form HR-106: EMERGENCY PREPAREDNESS CASH OUT FORM (Syracuse City)

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Syracuse City Corporation
Human Resources Department
Form HR-106
Updated November 2020
1
Syracuse City Corporation
EMERGENCY PREPAREDNESS CASH OUT FORM
Date Submitted: ____________________
Employee Information
Name: _________________________________________________ Employee Number: ________________
Department: __________________________________ Job Title: ____________________________________
Request Details
Cash Out Sick Leave
Dollar Amount Requesting: __________________________________________________________
Cash Out Vacation Leave
Dollar Amount Requesting: __________________________________________________________
Items Purchased:________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
Employee Signature: ______________________________________________________________
Approval Signatures:
City Manager: _____________________________________________________________
Department Head: _________________________________________________________
Administrative Services Director:______________________________________________
Human Resources: _________________________________________________________
For HR Purposes Only:
Hourly Rate of Pay: _______________
Number of Sick Leave Hours being Cashed Out: ______________________
Number of Vacation Leave Hours being Cashed Out: _________________________
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Form HR-106: EMERGENCY PREPAREDNESS CASH OUT FORM (Syracuse City)

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Completed 24 January 2021

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