Using the Sick Leave Bank. In order to be eligible to draw from the Sick Leave Bank, a staff member must:
Using the Sick Leave Bank. Approximate date of return to school (if known): Have you worked at all, in any capacity, since you became disabled? Yes No Do you have any other disability insurance coverage available to you? Yes No Are you or will you be employed while on Sick Bank? Yes No Are you or will you be participating in a business venture while on Sick Bank? Yes No FAILURE TO REPORT OTHER SOURCES OF INCOME WILL RESULT IN TERMINATION OF BENEFITS. I attest that the above statements are true to the best of my knowledge. Applicant’s Signature [or authorized representative] P HYSICIAN’S REPORT OF DISABILITY (Definition of disability is a generic definition, not a legal definition.) (please print or type)
