ATTACHMENT 4 Bereavement Leave Certification.doc
DOC document 23 KB Posted
- Solicitation number
- HDEC0812R0002
- Issued by
-
Defense Commissary Agency
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ATTACHMENT 4 Bereavement Leave Certification
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| ATTACHMENT 2 Performance Work Statement | — |
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ATTACHMENT 4
HDEC08-12-R-0002
ATTACHMENT 4
BEREAVEMENT LEAVE CERTIFICATION
REQUEST FOR PAYMENT
Contract Number:________________________________________________________ Store Locations: _________________________________________________________
Name of Employee:_______________________________________________________
Area of Operation (circle one): Shelf Stocking / Custodial / RSHA Name of Deceased:_______________________________________________________
Relationship to Employee:_________________________________________________
Dates of Bereavement Leave:_______________________________________________
I certify that the above named individual took Bereavement Leave in accordance with the provision of the Collective Bargaining Agreement (CBA) applicable to abovementioned contract and that the individual was paid according to its provisions. Pursuant to said agreement, the contractor is entitled to reimbursement.
(Signature)
(Name, Position, and Date)
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