2021 Vacation Pay Out Request Form

Employee Name: Employee #:

Position: Branch:

Payroll Department Use Only:

Vacation Leave Dates: yyyy/mm/dd
Vacation
Pay Out Request (lump sum from accrual balance): $ Code:

Place a check mark next to the pay period below in which you would like to have your vacation pay issued on.

PP # Pay Period Pay Date Selection

1 Dec 21, 2020-Jan 3, 2021 Jan 14
2 Jan 4-17, 2021 Jan 28
3 Jan 18-31, 2021 Feb 11
4 Feb 1-14, 2021 Feb 25
5 Feb 15-28, 2021 Mar 11
6 Mar 1-14, 2021 Mar 25
7 Mar 15-28, 2021 Apr 8
8 Mar 29-Apr 11, 2021 Apr 22
9 Apr 12-25, 2021 May 6
CSW Vacation March 31 Accrual Balances Paid Out - Fri. May 14
10 Apr 26-May 9, 2021 May 20
11 May 10-23, 2021 Jun 3
12 May 24-Jun 6, 2021 Jun 17
13 Jun 7-20, 2021 Jun 30
14 Jun 21-Jul 4, 2021 Jul 15
15 July 5 - July 18, 2021 Jul 29
16 July 19 - Aug 1, 2021 Aug 12
17 Aug 2 - Aug 15, 2021 Aug 26
18 Aug 16 - Aug 29, 2021 Sep 9
19 Aug 30 - Sept 12, 2021 Sep 23
20 Sept 13 - Sept 26, 2021 Oct 7
21 Sept 27 - Oct 10, 2021 Oct 21
22 Oct 11- Oct 24, 2021 Nov 4
23 Oct 25 - Nov 7, 2021 Nov 18
Non-CSW Vacation Accrual Balances Paid Out - Nov 18
24 Nov 8 - Nov 21, 2021 Dec 2
25 Nov 22 - Dec 5, 2021 Dec 16
26 Dec 6 - Dec 19, 2021 Dec 30

Please email your Vacation Pay Out Request to your branch specific payroll email or
payroll@carepartners.ca by the last day of the pay period. Written documentation is required by you to
access your vacation pay, therefore all vacation request payments MUST be emailed to the Payroll
department; phone messages will not be accepted as a request.

**please note that vacation pay will be issued as part of the regular payroll run, and not on a separate run.