Johnson School
Cornell University

Vacation Usage Consent Form
(Print, sign, and turn in to 235 Sage Hall)

I have asked for and received an advance of vacation leave prior to completion of the required period of one year of service.  In consideration of the extension of this benefit, I hereby authorize Cornell University to deduct the value of such advanced vacation leave from my final paycheck in the event that I do not complete one year of service.

 

Date(s) of Vacation Leave:

 

Employee Name:

 

Employee Signature
Date:

 

Supervisor Name:

 

Supervisor Signature
Date:

Last Modified: April 30, 2003