Fillable Terminal Leave Form 2018 (City University of New York)

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Terminal Leave Form 2018 (City University of New York)

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APPLICATION FOR TERMINAL LEAVE - CLASSIFIED STAFF
FOR EMPLOYEES IN BLUE AND WHITE COLLAR TITLES (ARTICLE IX SECTION 16 OF THE CONTRACT)
The terminal leave provision for all employees is as follows:
Terminal leave with pay shall be granted prior to final separation to employees who have completed at least ten (10) years of service on the
basis of one (1) day terminal leave for each two (2) days of accumulated sick leave up to a maximum of 120 days of terminal leave. Such leave
shall be computed on the basis of work days rather than calendar days.
- Any employee who as of January 1, 1975 has a minimum of fifteen (15) years of service as of said date may elect upon retirement a
terminal leave of one (1) calendar month (or 22 work days) for every ten (10) years of service pro-rated for fractional part thereof in lieu of any
other terminal leave.
- For the above option, any sick leave taken by the employee subsequent to July 1, 1974, in excess of an average annual usage of six (6)
days per year shall be deducted from the number of days of terminal leave to which the employee would otherwise be entitled to at the time
of retirement.
- In case the employee has exhausted all or most of the accrued sick leave due to a major illness, the College President in his/her
discretion, may apply two and one-fifth (2 and 1/5) work days for each year of paid service as the basis for computing terminal leave in lieu of
any other terminal leave.
- Where an employee has an entitlement to terminal leave and the University's fiscal situation requires that employees who are
terminated, laid off, or retired, be removed from payroll on or before a specific date because of budgetary considerations, the University shall
provide a monetary lump sum payment for terminal leave, in accordance with the provisions of New York City Mayor's Executive Order 31,
dated June 24, 1975, adopted by the University herein.
FOR EMPLOYEES IN THE 220 TITLES (APPENDIX A OF THE NEW YORK CITY COMPTROLLER'S CONSENT DETERMINATION)
Employees with 10 or more years of service who work at least 250 days per year earn terminal leave at the rate of one (1) month (22 work days)
for every ten (10) years of service pro-rated for every year above ten (10) years.
- If the employee selects, and as an alternative to the above method of computation, the terminal leave allowance may be computed
on the basis of one (1) day of terminal leave for each two (2) days of unused sick leave accumulation, to the maximum of one hundred (100)
days of terminal leave allowance. In this instance, terminal leave shall be computed on the basis of work days.
Accrued Annual Leave (up to a maximum cap of 2x the annual leave accrual rate, in accordance with PPB-18-90, dated 11/20/90) must
be exhausted followed by available Terminal Leave.
Annual Leave and Sick Leave are NOT accrued while on Terminal Leave.
Contract Title
Department
Empl. ID
OHRM-Terminal Leave Form - 2018 Page 1
Date of Birth
Name
City
State
Zip Code
Country
SS#
Phone
e-mail
TO BE COMPLETED BY EMPLOYEE
I will inform Human Resources promptly if I use any additional annual or sick days after the date below. I understand that if I use any
additional days of sick leave or annual leave, my expected retirement date may change or be adjusted, based on the final computation.
My expected retirement date is
Date
My last day of work is
Signature
College
Must have worked at least 250 work days per year
1 month (22 work days) for every 10 years of service
Pro-rated calculation=Years of service divided by 10 multiplied by 22
Computation of Terminal Leave for Blue and White Collar Employees (Check one option)
Annual Leave End Date
Annual Leave Balance
Sick Leave Balance
Original Date of Full-Time Appointment to University/College
Original Date of Full-Time Appointment at another agency, if applicable
Retirement Date
Last Date on Payroll
Terminal Leave End Date
Terminal Leave Begin Date
Annual Leave Begin Date
Date
Name
Leave usage has been verified and appropriate adjustments, if any, have been made to the leave balances.
I have reviewed and approve of the final computation of the retirement date.
Director of Human Resources/Designee
TO BE COMPLETED BY HUMAN RESOURCES
Compensatory Time Balance
Unscheduled Holidays, if any
OHRM-Terminal Leave Form - 2018 Page 2
Total Leave Balance
Human Resources must discuss the best option with the employee and advise accordingly
At least 10 years of service
Half of sick leave balance up to a maximum of 120 days
Total days
Total days
Computation of Terminal Leave for Skilled Trade Employees (Check one option)
Total days
Half of sick leave balance up to a maximum of 100 days
A minimum of 15 years of service as of January 1, 1975
(1 month (22 work days) for every 10 years of service)
Calculation=Subtract sick leave usage subsequent to July 1, 1974.
Total days
Time & Leave Balance as of date
Total Terminal Leave Balance
Signature
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Terminal Leave Form 2018 (City University of New York)

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Completed 18 December 2020

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