SICK LEAVE BANK REQUEST FORM Sample Clauses
The Sick Leave Bank Request Form clause establishes the procedure for employees to formally request additional paid leave from a collective pool of sick leave hours, known as the Sick Leave Bank. Typically, this clause outlines the eligibility criteria, the required documentation, and the steps employees must follow to submit their request, such as providing medical certification or detailing the nature of their illness. Its core practical function is to ensure a standardized and fair process for accessing shared sick leave resources, thereby supporting employees facing extended illness while maintaining administrative clarity and consistency.
SICK LEAVE BANK REQUEST FORM. Employee’s Name I am requesting number of days from the sick leave bank. The reason I am requesting sick leave is:
SICK LEAVE BANK REQUEST FORM. The sick leave bank has been established for use by eligible unit members whose earned sick and personal leave accumulation has been exhausted from a prolonged illness, medically required surgery, or injury and documented in writing by a physician. The application must be submitted in original format no earlier than ten (10) school days prior to a unit member exhausting all of her own personal sick leave days. Name: School/Location: Date of Request: Date sick and personal leave is exhausted: Number of days requested: Reason for request: Attach certification from a health care provider that the unit member’s condition prevents the unit member from performing her regular duties. Unit Member Signature Date Any grant of sick leave by the Sick Leave Bank Committee to an eligible member shall not exceed twenty
SICK LEAVE BANK REQUEST FORM. The sick leave bank has been established for use by eligible unit members whose earned sick and personal leave accumulation has been exhausted from a prolonged illness, medically required surgery, or injury and documented in writing by a physician. The application must be submitted in original format no earlier than ten (10) school days prior to a unit member exhausting all of their own personal sick leave days. The Sick Leave Bank Committee shall respond to all applications no later than ten (10) school days from receipt of completed application and all required documentation. Name: School/Location: Date of Request: Number of Days Requested: Date sick and personal leave is exhausted: Reason for Request: Unit Member Signature & Date Any grant of sick leave by the Sick Leave Bank Committee to an eligible member shall not exceed twenty (20) days. Upon completion of any grant of sick leave days by the Sick Leave Bank Committee, additional days may be granted upon demonstration of continued eligibility by the applicant. No unit member shall be granted more than one hundred eighty two (182) sick leave days for the same illness by the committee. Approved: #of Days Not Approved: Name School/Location Pursuant to ARTICLE X, Extended Leaves of Absence, I hereby request the following leave:
SICK LEAVE BANK REQUEST FORM. Employee Name: Date: