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Employment Agreements

Deferred Salary Leave Application

Deferred Salary Leave Application Form

Form Successfully Submitted

A. Employee Information

Confirmation will be sent to this address.

Supervisor Information

B. Deferral Information

The Deferral Period may commence on either the first day of January or the first day of July, following approval of the application. The Deferral Period cannot be less than two years and cannot exceed six years.

% of Deferred Salary

The percentage of salary I elect to defer per pay period per calendar year is identified below.

Please note that there are 24 pay periods/calendar year.

YEAR ONE

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#

YEAR TWO

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#

YEAR THREE

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#

YEAR FOUR

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#

YEAR FIVE

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#

YEAR SIX

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#

Notes:

  1. Normal gross pay means an employee’s regular salary, including any retroactive salary, but excluding overtime, shift differentials, temporary performance of higher level duty pay and other special payments.
  2. Percentage of salary to be deferred cannot be less than 10% and cannot exceed 33%.
  3. Interest earned is payable annually effective December 31.
  4. Any unpaid leave of absence during the Deferral Period will reduce the annual contribution to the deferred amount.

Leave Period

When the employee will be on their leave. The Leave of Absence must be planned to immediately follow the Deferral Period.

Authorization

Please ensure that you are not submitting confidential or sensitive information.