Open Door Employee Buy Back Form
Employee Name
First Name
Last Name
Date of Request
*
-
Month
-
Day
Year
Date
Number of Vacation Hours Requested to Buy Back (note: limit is 40 hours per pay period and can be made only on hours accrued over 40 hours, in increments no less than 12 hours)
Number of Sick Hours Requested to Buy Back (note: can only be made on sick time accrued over 200 hours and/or only once per year for up to 32 hours)
Employee email
example@example.com
Submit
Should be Empty: