Shared Sick Leave Pool
Donor Application
Shared Sick Leave Pool
Donor Application
Employee Name: |
Banner ID No.: |
| Department: | Work Phone: |
My signature below certifies that I am electing to donate hours of sick leave to the Delgado Shared Sick Leave Pool. I understand that I cannot designate a particular employee to receive the donated leave. I also certify that this donation is being made voluntarily and that I have not been directly or indirectly intimidated, threatened or coerced or promised any benefit by any employee. I further certify that my leave donation does not cause my balance to fall below 120 hours and I understand that this leave cannot be restored to me once it has been transferred to the Shared Sick Leave Pool.
Signature Date
For Payroll Manager Use Only | ||||
| I certify that the above listed employee has a sick leave balance sufficient to accommodate this donation request. | ||||
| Number of Hours of
Accrued Sick Leave: |
Number of Hours of Sick Leave Donated: |
Date Deducted: |
Remaining Sick Leave Balance: | |
| If denied, reason for denial: | ||||
| Payroll Manager Name: | Payroll Manager Title: | |||
| Payroll Manager Signature: | Date: | |||