ATTACHMENT_4_-_BEREAVEMENT_LEAVE_CERTIFICATION_-_Copy.docx
DOCX document 17 KB Posted
- Solicitation number
- HDEC08-15-R-0021
- Issued by
-
Defense Commissary Agency
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ATTACHMENT 4 - BEREAVEMENT LEAVE CERTIFICATION
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ATTACHMENT 4
BEREAVEMENT LEAVE CERTIFICATION
REQUEST FOR PAYMENT
PETERSON AFB, COLORADO
Contract Number:________________________________________________________
Store Locations: _________________________________________________________
Name of Employee:_______________________________________________________
Position (circle one): Stock Clerk / Lead Stock Clerk / Custodian / Lead Custodian
WHS/FLO / Lead WHS/FLO / Mat. Handler / Lead Mat. Handler
Area of Operation (circle one): Shelf Stocking / Custodial / RSHA
Name of Deceased:_______________________________________________________
Relationship to Employee:_________________________________________________
Dates of Bereavement Leave:_______________________________________________
Total Number of Hours Requested: _________________________________________
Per Paragraph 33.12 A of the CBA - Hours requested are not to exceed three (3) scheduled work days at straight time pay, pro-rated to be determined by number of hours which the employee averages during the normal work week immediately preceding the leave to begin.
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) |
| _________________________________ |
| (Company) |
File details come from the government source that posted it. Updated .