Leave Buy-out Form
Name: _______________________________ Date: ___________
Request a buyout of ______ hours. (Minimum 8 hours, maximum 80 hours)
I wish to waive my buy out ________.
___________________________________
(Employee Signature)
___________________________________
(Department Head Signature)
Leave Buy-back Policy
The Tom Green County Commissioners have approved a one-time leave buy-back policy for FY 2017 for
employees with 30+ years of service and at least 200 hours accrued leave. Employee must have 200
hours accrued leave on or before October 31, 2016 to qualify.
Eligible employees can sell up to 80 hours. If employee elects to sell less than the maximum the request
must be an 8 hour increment (i.e. 8, 16, 24, etc.). Only one request is allowed.
This form must be turned in to the Treasurer’s office no later than close of
business October 31, 2016.
