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2. 
3. Vacation Buy-Back Request Form

   I understand that I am requesting to sell back a portion of my earned, unused vacation hours back to the Town of Frederick. I understand that once I sell these hours back to the Town, they will be deleted from my bank, and will no longer be available to me. I understand that my vacation hours will be bought from me on an hour-for-hour basis, to be paid at my current standard hourly rate of pay. I understand that payment for these hours will be included with my regularly scheduled payroll deposit on the payroll date identified by the Payroll Administrator, and will be subject to all regularly occurring taxes and deductions. 

5. Name (first)*
6. Name (last)*
7. Department*
8. Date*
10. Total Number of Hours Currently in Vacation Bank:*
11. Total Number of Hours Requesting to Sell:*
13. Employee Signature:*
Leave This Blank:


15. 1. Receive an email copy of this form.
16. Email address

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17. Submit

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