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REQUEST FOR PAID LEAVE BUYOUT - Crisis _ Counseling Centers

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REQUEST FOR PAID LEAVE BUYOUT - Crisis _ Counseling Centers Powered By Docstoc
					                       32 Winthrop Street Augusta, ME 04330-5624



                     Request For: Buyout of Earned Benefit Time

               NOTE: Employee must have 100 hours of EBT remaining after buy out

Name:_____________________________________________________________________
                                 [PLEASE PRINT]

Program:___________________________________________________________________


EBT Hours Available:_________________________


Verified by Human Resource Director/HR Coordinator:
________________________________________________________ Date ____/____/____

Hours Requested: [not to exceed 80 hrs] ______________________

I understand that this request to buyout EBT is limited to 80 hours of accrued personal leave
per fiscal year.

Employee _______________________________________________ Date ____/____/____


Approved By:

Supervisor_______________________________________________ Date ____/____/____


Executive Director________________________________________ Date ____/____/____



cc: Personnel File/Payroll

				
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posted:12/3/2011
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