LOCAL___________________                             DATE_____________________________

With the 2001 Budget, OPSEU Locals now have access to additional funds for booking member time-off. This funding is available to assist the Local Executive Comittee and/or their members in the performance of their duties.

The annual funding level is determined by the following calculation:
          "A maximum of $12.50 per member in good standing. OPSEU Head Office will contribute            $10.00 per member with the Local to contribute the remaining $2.50 per member."

For greater clarification, the number of members in good standing in a Local will be based on OPSEU membership records for the month of December of the previous year.
Locals must ensure that their Local Trustee Audit Reports are up-to-date.
-  Local must  complete information requested in both boxes.

I affirm that this application for time-off has the approval of the Local Executive Comitee.
Name of Member(s):______________________________________________________________________
Purpose of Time-off:_______________________________________________________________________

_________________      __________________    ____________________    ________________________
Print Name of LEC Member          Signature of LEC Member           Date                                              Tel:
Note: A Local Executive Comitee Member cannot sign for his/her own application for reimbursement.


Date of last Local Trustee Audit Report Submitted:_____________________________________________
Number of Local Members in Good Standing:_________________________________________________
Maximum Local Entitlement: $________________ Estimated Amount Used To-Date: $_______________
                                                 (based on $12.50 per member, per year)

                                              Salary                           Benefits                                 Total
Estimated Time-off Costs: ________________        ________________          _____________________
Time-off to be paid by:______    Regular expense claim (proof of lost wages required)
                                ______    Employer's invoice ___________________________________________
                                                                                                              (Employer's Name)

Note: OPSEU will pay the member or employer for 100% of the total wage bill. The OPSEU Local Time-off Fund covers 80% of the cost, and the remaining 20% will be deducted from the Local next quarterly rebate(s). Any payment made by OPSEU in excess of maximum entitlement will result in a 100% cost recovery from the Local.

cc. Local Services Supervisor and Local Services Administrator 10/3/01