MADISON METROPOLITAN SCHOOL DISTRICT

VACATION CARRY OVER REQUEST

Date: Please Print

NAME: b#: b______

LOCATION: JOB TITLE:

BEFORE COMPLETING THE FOLLOWING SECTIONS, PLEASE CONSULT YOUR COLLECTIVE BARGAINING AGREEMENT FOR YOUR RIGHTS AND BENEFITS CONCERNING VACATION CARRY OVER. NOT ALL EMPLOYEES MAY BE ELIGIBLE FOR THE BENEFITS LISTED BELOW.

VACATION CARRYOVER: ADMINISTRATORS, CUSTODIANS, CLERICAL/ TECHNICAL (SEE), TRADES, PROFESSIONAL, NON-REPRESENTED—5 DAYS MAXIMUM.

I hereby request days/hours of personal vacation that was earned this year (number of days/hours, 5 days maximum) to be carried over until next year.

SICK LEAVE CONVERSION: CUSTODIANS, CLERICAL/TECHNICAL (SEE), TRADES, PROFESSIONAL, NON-REPRESENTED EMPLOYEES ONLY. 5 DAYS MUST BE CARRIED OVER TO VACATION PRIOR TO CONVERTING ANY DAYS TO SICK LEAVE.

I hereby request days/hours of personal vacation that was earned this year (number of days/hours) to be deposited into my personal sick leave account.

DEADLINES APPLY BY USE BY ______Administrators: June 15 N/A Employee’s Signature

Custodians & Dec. 10 June 1 ______Trades Supervisor’s Signature

SEE, Professional, Dec. 10 May 31 ______Non-Represented: Human Resources Signature

Shared/hr/docs/vac carove RETURN ALL COPIES TO THE BENEFITS DIVISION—HUMAN RESOURCES

Copies: White-Payroll Yellow-File Pink-Supervisor Goldenrod-Employee

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