Revised January 2017
DIRECT SICK LEAVE DONATION FORM
INFORMATION FOR EMPLOYEES
1. To make a sick leave donation, complete and sign Section I of this form and return it to Human
Resources.
2. You may directly grant up to 40 hours per year of your personal sick leave to another employee at the
College. However, your personal sick leave balance must be at least 40 hours after you make the
donation.
3. The employee who receives donated sick leave can only accept a total of 240 hours in a 12 month
period. The portion of your donation that has been accepted will be subtracted from your personal sick
leave balance. You will receive notification about the amount accepted as soon as possible after the
deadline date for donations.
SECTION I (to be completed by donor)
Name:
Department:
Amount to Donate: hours
Signature: Date:
Section II (to be completed by HR/Payroll)
Sick Leave hours to be processed:______________
Credited to recipient on pay period ending: ________________
Signature Date
click to sign
signature
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