Department of Environmental Protection
Request For Annual Leave Payout For Career Service Employees
Employee ID Number:
I am requesting to be paid for _____ hours of annual leave (maximum 24 hours – must use
whole numbers). I understand that after this payout, I must still have a balance of at least
twenty-four hours of annual leave and this payout will be counted towards my 240-hour
Please check each of the following categories to confirm eligibility for this payment:
I certify that I have been continuously employed by the State of Florida for at least
twelve months or will have twelve months of continuous service on or before
December 1, of the current year.
I certify that I will have an annual leave balance of at least 24 hours after payout of
the above requested hours.
I understand that I am responsible for working with my supervisor to ensure that all
timesheets up through November 30, 2009, are submitted and approved in People
First by close of business on Friday, December 4, 2009. I also understand that my
payment will be cancelled if I do not comply with this requirement.
I understand that if I have low annual leave balances I will be required to provide
verification of any leave used during the first part of December 2009 before the
payment will be finalized.
I certify that I have not been paid the lifetime maximum of 240-hours and this request
will not exceed the allowable 240-hours.
Employee Signature Date
This is to certify, to the best of my knowledge that above employee is eligible to participate in
Personnel Signature Date
This completed form must be received in the Bureau of Personnel Services via fax at (850) 412-0751 on
or before the close of business on Friday, October 30, 2009.