Recall/Layoff Notification Form
*Fields marked with an asterisk(*) are mandatory. Other fields only need to be completed if previous information has changed.
Employee Information
*Name:
Employee *Employee #
Home Address No. & Street:
City/Town:
Postal Code:
Home Phone:
Cell Phone:
Assignment #:
*Ministry:
*Branch:
*Work Email:
*Manager/Supervisor Name
Work Phone #:
Recall (Select one):
* Short Term Recall
Position Information
*
Seasonal Recall
*Recall Date
/
/
dd
mmm yyyy
MIDAS Position Number:
First Day Worked
Job Occ Code:
Working Title:
/
/
mmm yyyy
dd
Grade (Class Level):
Paylist:
HR Org:
Pay Stub Work Address (street, town/city):
Pay and Costing:
Salary: $
(Hourly)
Costing Information: Entity
/ Program
Tool Allowance – Fleet Services?
Yes
Eligible for Northern District Allowance?
/ Org
No
/ Location
/ Project (if appl)
Eligible for Special Northern Leave?
Yes
No
Location:
1
2
3
Yes
4
Kitchen Meals:
Yes
(Environment only)
Other Earnings/Deductions (e.g.Staff Housing, etc):
EDO and Hours of Work (Select one):
* Full Time
st
Date of 1 EDO:
/
/
mmm
dd
*
Stat holidays:
Observed
Actual
Modified Hrs of Work:
Yes
No
No
Less Than Full Time
Start Time:
yyyy
No
am /
pm)
Length of Lunch:
(minutes)
Normally works Sat & Sun: Yes
No
Letter of Understanding # :
:
(
Altered Work Agreement:
EDO Schedule:
Yes
A
B
C
No
Vacation Pay Type – Note: Vacation is prorated based on hours worked and length of seasonal hours worked.
Paid Days
% paid each cheque
SGEU Section
6
7
10
11
12
Subsection
Regulated 37 1/3 5/5/4 (F)
Office 7.2 – 72 Hr Biweekly (O)
Fires 5/5/4 Modified Biweekly (W)
13
16
17
18
20
21
22
Highways Office 5/4 (G)
Pilots Paid Daily Rate (P)
5/5/4 Modified Biweekly (X)
23
25
Modified 5/4 72 Hr Biweekly (M)
Field Hours (U)
Layoff (All fields are mandatory)
Last Day Worked:
/
dd
Date of Last EDO:
/
mmm yyyy
/
dd
/
mmm yyyy
Last Effective Day of Employment:
/
/
Final Pay Stub Address (street, town/city):
dd
mmm yyyy
(fill in address if different than above)
Note: Must include EDO, SDR if it falls on last day
Separation reason:
Short – term
Shortage of Funds
Work Shortage
Requested early
Return to School
Carryover - If this section is not completed entitlements will be paid out at time of layoff
Vacation Hours:
Yes
No
TIL Hours:
Yes
No
Carryover Maximum-40 hrs without approval; over 40 hrs requires approval
Carryover Maximum-120 hours
Northern Leave Hours:
Yes
No
Outstanding debt to be collected
Yes
EDO (Field Only) Hours
Reason:
Manager / Supervisor / Delegate Signature:
Routing: Send completed form to:
Recall/Layoff Notification Form
No
Note: Please include any outstanding Return in Service Commitment
No If yes, amount outstanding:
Manager / Supervisor / Delegate Print Name:
Yes
Date:
Phone Number:
Employee Service Centre 2100 Broad Street Regina, SK S4P 1Y5
Fax: 306-798-9966 or 1-877-852-9219
Email: esc@gov.sk.ca
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Version #13; 05-Mar- 2014