State of California Department of Corrections and Rehabilitation Memorandum Date: November 7, 2014 To: ALL CALIFORNIA DEPARTMENT OF CORRECTIONS & REHABILITATION (CDCR) STAFF Subject: CATASTROPHIC TIME BANK REQUEST FOR MITCHELL A. GARCIA This is to announce the approval of a Catastrophic Time Bank that has been established for Mitchell Garcia, he has been off work due to injury/illness. As of November 17, 2014, he will have exhausted all leave credits, Employees wishing to donate Personal Leave, Vacation, Compensating Time Off (CTO) and/or Holiday Leave credits should complete a CDCR 869, Catastrophic Time Bank Donation Authorization. This form is available in all CDCR Personnel Offices. Completed CDCR 869 donation forms should be submitted through the donor's Personnel Office, who will forward them to the Personnel Office at North Ken State Prison, PO Box 5007, Delano, CA 93216 If you need assistance, please contact the Personnel Office at (661) 721-2345, extension 6703. ee = SANDRA ALFARO Warden North Kern State PrisonSTATE OF CALIFORNIA DEPARTMENT OF CORRECTIONS CATASTROPHIC TIME BANK DONATION AUTHORIZATION el coces Se cemenicts PLEASE PRINT OR TYPE. Settee [PART A= DONATION INFORMATION a : 5 [powon no oumneTs A sda ALL Cons ro VouR nxsoNNeL Ornce = 5 MITCHELL A. GARCIA 182-203-9662-026 06 cocr NKSP "certify tat Ihave sufficient eave credits currotly wallable Yo ake this donation understand Wat ins donation Ws Trevosubl- The Gon bination ‘ofthis donation and my personal leave usage forthe pay peod from which these eres are deducted exceeds my available eredis, 1 authorize the ‘automatic establishment and collection of an accounts receivable based onthe numberof leave credits overused. {understand tha he fll net dollar mount will be automatically deducted from my next available pay warrants) until the overpayment fs eollected in fl, ‘YOUR NAME WILL BE IDENTIFIED ASA DONOR UPON REQUEST OF THE RECIPIENT UNLESS YOU CHECK THE BOX REQUESTING ANONYMITY PART B= DONORS PERSONNEL OFFICE ATER OMPLITE PART. RETA MAK Cars AVE GOLDIEIROD TODONOR.FeRwARD NENG COIS 10. RECINENTSrsorom. orice [[)_ treqvest aNonvanry, WAS THE ABOVE DONATION DECUCTED FROM THE DONOR'S LEAVE BALANCES)? YES ALL leve cei) were dedeted fom the donors balances frre re ons peBCCTED during be [71] X65: PARTIAL teas rts) ware ded fon the donors baeesdinng [PROD the The following were NOT deducted. " 'NO- Leave credit(s) donated were NOT [_] wemansastoueov ina contact READY DaTED secepted because: INSUFFICIENT LAAVECREDTS AVAILABLE PARTC- RECPIENTS PERSONNEL OFFICE ro {SPNTLETE RAR RETAN(OR DAL, St CANARY 495 GREEN Cov 70 Donn, omWARD HENS ToPERSOAN Gece E ABOVE DONATION USED BY THE RECIPIENT? YES ALL leave cris) were ued during the ae ee ‘YES PARTIAL leave credit(s) doducted were used during he erenens) “The following were NOT used anda hoehy retin een [_] No Leave cits donated were NOT needed and we herby reamed ote donor