UCLA Billing Statement for Reimbursement of Costs Associated with Leaves of Absence for Union Business1 (AFSCME SX and PCT represented employees)
Please complete and forward to Campus Human Resources, Labor Relations Unit, Attention: Roman Gallego.
DEPARTMENT INFORMATION Department Name: _________________________ Department Contact: ________________________ Telephone No.: _______________________ EMPLOYEE INFORMATION Employee Name: ___________________________ Employee ID No.: ____________________ Position Title: _________________________________________________________________ Date of Union Leave _________________________ ____________________________ (From) (To) Account CC Fund Project Sub: ___________________________ Total Monthly Salary: ___________________________ Total Associated Benefits Cost (36%): ___________________________ * Total Amount Due: ___________________________
* Please make check payable to the UC Regents
PAYROLL USE ONLY Attention: Lucy Eugenio
Total Amount Credited: __________________________________________ Account Fund Credited: ___________________________________________
1
These guidelines describe a temporary process to apply until such time as the Office of the President develops a system-wide process.
CHR - Labor Relations Updated: February 8, 2006