State of New York
Holiday Pay Waiver

(For Classified Service Employees in
Negotiating Units 01, 02, 03, 04, 05, 06, 31, and 61)

(click the box in front of your negotiating organization)

Payroll Agency

I am eligible for additional money if I am required to work during my regular working hours on any day observed by the State as a holiday. Between April 1, and May 14, , I may give up my right to such additional money and choose to receive time accruals instead. If I previously gave up my right to receive money for holiday work, I have until May 14, to cancel this decision and start receiving money again.

I wish to change the way in which I am currently being paid for holiday work as follows:

I am now receiving money and I wish to change to receive time accruals
I am now receiving time accurals and I wish to change to receive money

I understand that this is the way I will receive holiday pay from now on. I will not be able to change this until at least April 1, and it will continue this way unless I do change it during the next open period.

(Please Type)

Work Location:      
Social Security Number:    
    _________________________   ________
    Signature   Date

Send to the campus payroll office by close of business May 14,