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Category: Leave Forms

Military Leave Worksheet

This form is for employees who will be out on Military Leave (after 15 days of Military Leave has been exhausted).  The form allows the employee to select options for payment of premiums during military leave and designates how much personal leave the employee would like to use. Military Leave Form (Excel) Military Leave Form (PDF)

Request of Payment of Leave for LTD Approved Employees

This form is for employees who are approved for LTD only.  Use this form to indicate when you would like any eligible leave balances to be paid out. Request for payment of leave for LTD approved employees  

Program I (Pre-2006) & Program II (Pre-2014) Sick & Converted Sick Leave Transfer Request

Complete this form to request a transfer of Program I (Pre-2006) and/or Program II (Pre-2014)  Sick or Converted Sick to use in a current pay period.  Submit the form to your payroll processor or if ERIC is responsible for processing your payroll – fax to 801-538-3616 or email to ericpayroll@utah.gov. VERY IMPORTANT – Please note:  Transfers are not available for immediate use, after the adjustment has been made the change must go through an update process before the hours will be available for you to enter – if you intend to enter the hours in the Employee Self Serve ...

One Time & Irrevocable Pre-2006 Transfer Request

As of January 1, 2011, an employee who is participating in the Unused Sick Leave Retirement Program I under Section 67-19-14.2 (Utah Code Annotated 1953), may make a one-time and irrevocable election to transfer all unused sick leave hours which shall include all converted sick leave hours under Section 67-19.14.1 (Utah Code Annotated 1953), for use under the Unused Sick Leave Retirement Program II. One-Time Irrevocable Authorization to Transfer All Pgm I Sick & Conv Sick to Pgm II (1)  

FI11 Leave Donation Form

Complete this form to donate Annual, Converted Sick or Excess hours to your agency’s leave bank or to a specific individual within your agency’s leave donation guidelines. The link below will take you to the DAS Finance Forms web page to access the most recent version of this form. Finance forms are fillable PDFs. Forms ending with an asterisk save information to and retrieve information from their database and require a login to access. These forms must be opened in a browser other than Chrome. If you get the “Please wait…” message after clicking on a form link, use the ...

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