UNIVERSITY OF CALIFORNIA, RIVERSIDE
TRANSITION ASSISTANCE PROGRAM
APPLICATION FORM
Name: / Payroll Title:Department Number: / Employee ID #:
Work Location: / Work Number:
Home Address: / Home Phone #:
City, State, and Zip Code:
The UCR Transition Assistance Program offers eligible employees who are transitioning from either a monthly to a biweekly pay cycle OR a biweekly to a monthly pay cycle, two options to assist them in meeting their financial obligations during the transition period, due to the implementation of Career Tracks. Affected eligible employees may apply for the vacation/compensatory time (CTO) cash-out program OR the short-term (no interest) loan program. Completed and signed applications may be submitted to Linda Gaddie in Human Resources via e-mail or hardcopy on or after September 17, 2015, but no later than 5:00pm, on September 27, 2015.
Option A – Vacation/CTO Accrual Cash-out
(A maximum of 80 accrued hours may be cashed out)
I, , authorize a cash out of hours from my existing vacation accrual balance and/or hours from my existing CTO balance (not to exceed a total of 80 hours.) I understand that my vacation accrual balance will be reduced by the number of hours I have authorized.
Option B – Short-term (No Interest) Loan Program
(Minimum amount of $100; maximum amount of $1,000)
Loans are to be repaid in equal installments over 12 biweekly pay periods via payroll deduction, with the first payment deducted from the December 1, 2015 paycheck (for monthly pay cycle) OR the December 2, 2015 (for biweekly pay cycle) and the final repayment deducted from the April 29, 2016 paycheck (for monthly pay cycle) OR May 18, 2016 paycheck (for biweekly pay cycle).
I, , am requesting a Short-term (no interest) Loan in the amount of
$
(Loan Amount in $) (Loan Amount written out in words)
I have also completed, signed and attached the required promissory note.
I understand that the vacation/CTO accrual cash-out OR short-term (no interest) loan I’ve applied for will appear on my October 21, 2015 paycheck (for those moving to a monthly pay cycle) OR my October 30, 2015 paycheck (for those moving to a biweekly pay cycle). Furthermore, if I have applied for the short-term (no interest) loan, I authorize the University of California to begin taking payroll deductions from my December 1, 2015 paycheck (for monthly pay cycle) OR December 2, 2015 (for biweekly pay cycle) paycheck in equal installments so that the entire balance of my loan will be paid in full no later than April 29, 2016 (for monthly pay cycle) OR May 18, 2016 (for biweekly pay cycle).
Signature Date
(Please read and sign below)
In the event that I am separated from University employment, whether voluntary or involuntary, the University will declare the outstanding balance of the loan immediately due and payable. I agree that the balance of the loan may be deducted from my final earnings even if the amount due exceeds the amount of the biweekly payment. I understand that I may be required to sign an acknowledgement form at the time of my separation that provides the amount of the outstanding balance and confirms my agreement to deduct that amount from my final earnings. I agree that if the net amount of my final earnings is insufficient to repay the loan, I will repay the remaining outstanding balance with a personal check.
Signature Date
The following information is to be completed by Payroll:
Option A: Eligibility to participate in the Vacation/CTO Cash-out program and verification of the vacation leave/CTO accrual balance:
Approved by:
Option B: Eligibility to participate in the Short-term (No Interest) Loan program:
Approved by:
For Transition Assistance Program questions please contact Chrystelle Zimmerman (x 2-5086) or Emma Geach (x 2-3575) or refer to the Frequently Asked Questions section of the Career Tracks website: http://hr.ucr.edu/salary/careertracks.html
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