Report Under P.G. 205-21 POLICE DEPARTMENT CITY OF NEW ...

[Pages:6]POLICE DEPARTMENT CITY OF NEW YORK

Report Under P.G. 205-21

From:

Commanding Officer, Military and Extended Leave Desk

To:

Uniformed Members of the Service

Subject:

INSTRUCTIONS AND FORMAT TO FOLLOW WHEN REQUESTING A LEAVE OF ABSENCE WITHOUT PAY FOR HARDSHIP PURPOSES.

1. Prepare a report using the attached sample and format as a guide. This report will be addressed to your Commanding Officer and forwarded to this command after the C.O. endorses the request (after conferral with the Borough Commander).

2. You must surrender all Department property, as listed on the

Discontinuance of Service Form before starting this leave to your Commanding Officer.

Restricted/HQ Annex Parking Permit must be returned to the Integrity Control Officer at your command. All Department property will be recorded on the Property ReceiptDiscontinuance of Service Form, the original will be forwarded, along with the green copy of the Property Clerk's Voucher, to the Commanding Officer, Military and Extended Leave Desk. If applicable, all members must return their personal portable radio with all accessories to Communications Division, Electronics Section 50-16 59th Place, Woodside, NY 11377. If applicable, all members, must return their personally assigned cellular telephones and all accessories to Communications Division, Telecommunications Unit, One Police Plaza, Room 910B. Metro Card must be delivered to Employee Management Division located in 1 Police Plaza, Room 1014 (this

will be noted on Property Receipt-Discontinuance of Service Form or on a separate

receipt). All members of the service MUST forward their Shield and Identification Card to the Shield and ID Unit, 1 Police Plaza, Room 502. Attach a copy of all property receipts to leave request package.

3. All accrued vacation and other accrued leave MUST be exhausted prior to start of leave. As a uniformed member, vacation is granted January 1st for that year. You DO NOT accrue vacation while on an UNPAID leave, thus vacation may not be taken before a leave which includes vacation time which would have accrued during the months you are on a leave of absence. If vacation time was already taken, it will be deducted from your vacation allowance for the following year when you return to active employment with the NYCPD. You must reimburse the NYCPD for vacation days which you were paid, but were not entitled to.

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4. Health Insurance will not be paid by the City of New York while on a Hardship Leave of Absence. If you have any questions concerning your health insurance coverage, please contact the Health Insurance Section at (646) 610-5122.

5. During the time you are in a no pay status you will not be credited for pension purposes and this time will be considered a break in continuous service. AS A RESULT OF THIS BREAK IN CONTINOUS SERVICE, YOUR APPOINTMENT DATE WILL BE ADJUSTED (EQUATED) FOR PENSION PURPOSES. If you have any questions, call the Pension Section at 212-693-5100.

6. After the leave of absence is approved, you will be transferred to the Military and Extended Leave Desk (MELD), located at 1 Police Plaza, New York, NY., Room 1008. If you plan to terminate your leave prior to its scheduled expiration date, contact MELD for an appointment. You must notify the Commanding Officer, Military and Extended Leave Desk, in writing of any change of address or telephone number while on leave including any temporary change of address or telephone number. If you are permanently changing your address or telephone number, you will need to officially inform the Department by preparing form PD451-021 (Change of Name, Residence or Social Condition).

7. You must not accept outside employment while on this leave without the Department's prior approval, obtained through the Commanding Officer, Military and Extended Leave Desk, by submitting an Off-Duty Employment Application (PD407164), as per Patrol Guide Procedure 205-40.

8. While on leave, you will respond to and make all court appearances for any Department hearings or trials that are pending in which you are a witness, arresting officer, or respondent. In addition, all Members of the Department must report all Police Incidents/Off-Duty Incidents as per Patrol Guide Procedure 212-32, and any Family Offenses and Domestic Violence, involving Members of the Department, as per Patrol Guide Procedure 208-37.

9. If you have any further questions, please call the Military and Extended Leave Desk at (646) 610-5513.

Rev. 07/09

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SAMPLE FORMAT

SAMPLE FORMAT

POLICE DEPARTMENT CITY OF NEW YORK

Date _________________

From:

P.O. Janice Jones; Shield# 9999; Tax# 999999; SS# 9999

To:

Commanding Officer, 099 Precincts

Subject:

REQUEST FOR A HARDSHIP LEAVE OF ABSENCE

1.

It is requested that I be granted a Hardship Leave of Absence without pay

from 0001 hours,

to 2400 hours,

. (Note: leave

of absence cannot exceed 365 days and is granted on a calendar day basis and not work

days).

2.

As a uniform member appointed on

, I understand that

I am not entitled to use any annual vacation which would have accrued while on this

unpaid leave, and that I must exhaust all other accrued time which I earned prior to

commencing this leave. I further understand that if I have already taken any vacation

which would have accrued while on this leave, such leave will be deducted from the next

year's allowance. If for any reason, I do not return to active employment with the New

York City Police Department, I will reimburse the New York City Police Department, for

vacation days that I was paid for that I did not accrue.

3.

I am aware that while on this leave, my health insurance will not be paid

by the City of New York. Additionally, I am aware that the time I am in a no pay status

will not be credited for pension purposes and this time will be considered a break in

continuous service. AS A RESULT OF THIS BREAK IN CONTINOUS SERVICE,

MY APPOINTMENT DATE WILL BE ADJUSTED (EQUATED) FOR PENSION

PURPOSES.

4.

Before starting my leave, I will surrender all Department property, as

listed on the Discontinuance of Service Form to my Commanding Officer. The

Restricted/HQ Annex Parking Permit was returned to my Integrity Control Officer. I

delivered my Shield and Identification Card to the Shield and ID Desk, and the Metro

Card to the Employee Management Division. Copies of the Property Receipt-

Discontinuance of Service Form, Property Clerk's Voucher, and receipt for my Shield

and ID Card are attached.

5. While on leave, I may be reached at: Full Address (including apartment number, city and zip code) Telephone Number (including area code)

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Cell Phone Number Resident Precinct NOTE: RESIDENCY REQUIREMENT REMAIN IN EFFECT WHILE ON LEAVE OF ABSENCE (i.e. NYC OR THE SIX RESIDENCE COUNTIES). 6. I will notify the Commanding Officer, Military and Extended Leave Desk, in writing of any change of address or telephone number while on leave including any temporary change of address or telephone number. I am aware that if I am permanently changing my address or telephone number, that I will need to officially inform the Department by preparing form PD451-021 (Change of Name, Residence, Social Condition). 7. I agree that I will not accept outside employment while on this leave without the Department's prior approval, obtained through the Commanding Officer, Military and Extended Leave Desk, by submitting an Off-Duty Employment Application (PD407-164), as per Patrol Guide Procedure 205-40. 8. I understand that while on this leave, I will respond to and make all court appearances for any Department hearings or trials that are pending in which I am a witness, arresting officer, or respondent. I also understand that I will report all Police Incidents/Off-Duty Incidents, Family Offenses, and Domestic Violence Incidents, as per Patrol Guide Procedures 212-32 and 208-37.

(Signature) Janice Jones Police Officer

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Report Under P.G. 205-21

SAMPLE FORMAT

SAMPLE FORMAT

1st ENDORSEMENT

Commanding Officer, 099th Precinct, to Commanding Officer, Military and Extended Leave Desk, (Date). Conferred with Borough Commander. All Department property (except Patrol Guide) has been surrendered and recorded on the Property ReceiptDiscontinuance of Service Form (attached) and all weapons as listed on member's force record card, have been vouchered and recorded on the Property Clerk's Invoice (green copy of voucher attached). Recommend APPROVAL (Disapproval as appropriate).

(Signature) Henry Ford Captain

THIS LEAVE REQUEST WILL BE FORWARDED DIRECTLY TO THE MILITARY AND EXTENDED LEAVE DESK.

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Report Under P. G. 205-21 P. G. 205-28

POLICE DEPARTMENT CITY OF NEW YORK

Subject:

LEAVE OF ABSENCE WITHOUT PAY FOR THIRTY (30) CALENDAR DAYS OR MORE FOR THE PURPOSE OF HARDSHIP, EDUCATION, CHILD CARE, FMLA, ETC.

"I have requested an extended leave of absence for thirty days or more for the purpose of ________________________ and not for other full time employment. I am aware that full time employment is any employment requiring over twenty (20) hours a week per the General Municipal Law, Section 208D. I agree if this leave is approved, that I will not accept other employment while on this leave without the Department's prior approval, obtained through the Military and Extended Leave Desk. Failure to obtain such approval may be cause for termination of my employment with the Police Department."

NOTARY STAMP/SEAL

_________________________

Signature

Date

State of ________________________ County of ______________________ City of _________________________ On this __________________ day of _________________________ 20___ Before me personally came ________________________________ to me known and known to me to be the individual described herein and who executed the foregoing instrument, and duly acknowledged to me that he/she executed the same. _______________________________ Notary Public/Commissioner of Deeds

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