ࡱ> Z\Y#` Objbj >(A :::::::Tjjj8<6b))))K)Ea$"cheva:hA@hha::;ah::)h)'|::( `)&j~" (),b06b(ff$(f:(hJ3<oaat6bhhhh  N$r:::::: The University of ϲʿԤ Ontario DEFERRED SALARY LEAVE for Academic Staff APPLICATION AND AGREEMENT I have read and agree to the terms and conditions of the Deferred Salary Leave Article applicable to me* and hereby apply for a deferred salary leave as follows: I request a Leave Period of ________months to commence effective the first day of (January or July) ________, 20___ and ending the last day of ______ 20____. I request that I receive a reduced salary effective from the first day of ____20____ to the end of the month preceding the first month of the Leave Period (the Deferral Period). The amount of the deferred salary shall be equal to ________% (between 5% and 25%) of my regular annual earnings. d) I agree to return to the University for full-time employment immediately following the Leave Period for a work period equal to the Leave Period. I agree to continue my statutory deductions based on the actual salary received during the Deferral Period. I agree to continue my University benefit deductions based on my full-time regular salary during the Deferral Period. I elect or do not elect to contribute the full costs (University and my share) of the pension and benefit programs during my Leave Period. (Note: If you do not elect to continue your benefit contributions, your group benefit coverage will cease during your Leave Period. Members Name: __________________________ Employee Number: __________________________ Unit/Department/School (if applicable): __________________________ Signature: __________________________ ________________________ Member Date Signature: __________________________ ________________________ Chair/Director/Supervisor, if applicable Date Signature: __________________________ ________________________ Dean/University Librarian Date Signature: __________________________ ________________________ Provost or designate Date * Librarians and Archivists see: Deferred Salary Leave article in the Librarians and Archivists Collective Agreement; Faculty represented by UWOFA see: Deferred Salary Leave article in the Faculty Collective Agreement; and Physicians see: Deferred Salary Plan as outlined in the Official Plan document.     !"7Jefgi ówl^wlPwEhlOJQJ\^Jh ihTOJQJ\^Jh ihViOOJQJ\^JhTOJQJ\^Jh ihvfOJQJ\^Jh ihl5OJQJ\^Jh ihl6OJQJ\^Jh ihlOJQJ\^Jh ihl:OJQJ\^J hYMhYMhlCJaJhChTCJaJhChlCJaJhCh$CJaJhCh$6CJaJ"Lfg ] ^ e f $ nW^`Wa$gd i$ & F XW^`Wa$gd i$ W^`Wa$gd i$ & F W^`Wa$gd i$a$gd igdYM $a$gdl $a$gd$AN  " % & . < \ m n v }   C I Z [ ] ŷ㷩㓅wiYiwwKh ih|}OJQJ\^Jh ihZz6OJQJ\^Jh ihZzOJQJ\^Jh ihOJQJ\^Jh ihTOJQJ\^JhTOJQJ\^Jh iOJQJ\^Jh ihvfOJQJ\^Jh ihy9OJQJ\^Jh ihA!IOJQJ\^Jh ihl6OJQJ\^Jh ihlOJQJ\^Jh ihYMOJQJ\^J     }    , H I J L P V Z f g ؼʣʣؕyii[PhOJQJ\^Jh ihROJQJ\^JhThvf6OJQJ\^J7jh ihROJQJU\^JmHnHsH tH uh ihvfOJQJ\^Jh ihZzOJQJ\^JhQjOJQJ\^Jh ihQjOJQJ\^Jh ihy9OJQJ\^Jh ihlOJQJ\^Jh ihOJQJ\^Jh iOJQJ\^Jf I J _ ` DWX8gdViOdhgd i$a$gd i$ W^`Wa$gd i$ & F W^`Wa$gd i   ^ _ ` i o q r s 㤒n_Pn>nn_#h ihViOCJOJQJ\^JaJhCCJOJQJ\^JaJhCJOJQJ\^JaJ#h ih iCJOJQJ\^JaJ#h ihlCJOJQJ\^JaJ#h ihlCJOJQJ\^JaJh ihlOJQJ\^JhOJQJ\^JhThZz6OJQJ\^JhTOJQJ\^Jh iOJQJ\^Jh ihvfOJQJ\^Jh ihZzOJQJ\^J  #)*BCDMPQRVWXbdy~޺޺̨އxި̨fff̨f#h ihJ|CJOJQJ\^JaJhCJOJQJ\^JaJh iCJOJQJ\^JaJ#h ihlCJOJQJ\^JaJ#h ihlCJOJQJ\^JaJ#h ihy9CJOJQJ\^JaJ#h ihViOCJOJQJ\^JaJ#h ih iCJOJQJ\^JaJhCCJOJQJ\^JaJ"Mb>@A̺ިޙިިި{l`l`l`lQlhZJhZJCJOJQJaJhZJCJOJQJaJhZJhCCJOJQJaJhCCJOJQJ\^JaJhViOCJOJQJ\^JaJhCJOJQJ\^JaJ#h ih iCJOJQJ\^JaJ#h ihlCJOJQJ\^JaJ#h ihRCJOJQJ\^JaJ#h ihViOCJOJQJ\^JaJhTCJOJQJ\^JaJACDFGIJLMNOgdZJgdViO ABDEGHJKNOhZJhCCJOJQJaJh[jh[U < 00P:pViOBP/ =!"#S$S% L@L Normal1$7$8$H$CJ_HaJmH sH tH Z@Z y9 Heading 1$<@&5CJ KH OJQJ\^JaJ DA@D Default Paragraph FontViV  Table Normal :V 44 la (k(No List <&< Footnote Reference4@4 Header  !4 @4 Footer  !6U@!6 vf Hyperlink >*B*phH2H R Balloon TextCJOJQJ^JaJO (zzO "Lfg  ]^efIJ_`DWX8P Y Y Y #cc _ PSPSPSPSPSPSPSPSPSPSPSPSPSPS"Lfg  ]^efIJ_`DWX8A C D F G I J L M P 0000L0L0L 0L0L 0L0L 0L0L0L0L 0L0L 0L0L 0L0L0L0L0L0L0L0L0L0L0L0L0L0L0L0L0L0L@0h00@0h00@0h00@0h00"Lg ]^efIJ_`DWX8P 0 0 00U 0U0U 0U0U 0U0U0U0U 0U0U 0U0U 0U000000000000j0  AO f O N 8@(  (  (  B S  ?JKO   txh tl !!4!t!!`P !!P 9*urn:schemas-microsoft-com:office:smarttagsplace=*urn:schemas-microsoft-com:office:smarttags PlaceName=*urn:schemas-microsoft-com:office:smarttags PlaceType  -A M P fA M P "7JKKefgg   &&mnvvHHJLfg__`io)*++GGMV~Mb@ A A C C D D F G I J L M P A P Bp 8tg#K0H|:P$d876o8t)PrKh ^`hH)h pp^p`o(hH)h @ L@ ^@ `LhH.h ^`hH.h ^`hH.h L^`LhH.h ^`hH.h PP^P`hH.h  L ^ `LhH. 88^8`o(hH) 88^8`hH. 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