Catastrophic Leave Donation Program
Human Resources/ Payroll Services
Submit to: Payroll Services
Catastrophic Leave Donation Program
JA 110
Revised 11/13/2017
Phone:
To: PAYROLL SERVICES, M/S JA 110
Employee ID:
Department Name:
I would like to donate the following number of hours to the employee (named below) participating in the
CSU Catastrophic Leave Donation Program.
I understand that I may donate up to the maximum number of sick and/or vacation leave credits for my
Bargaining Unit per fiscal year
. Leave credits may be donated in increments of one hour or more. The
recipient employee must have exhausted all available leave credits before actual transfer of my credits.
Leave Credit Donation Maximum
Units R01 (UAPD), R11 (UAW-TA’s only)
16 hours of leave credits per fiscal year
Units R02, R05, R07, R09 (CSUEU), R03 (CFA), R04
(APC), R06 (SETC), R08 (SUPA), C99 (Confidential), MPP,
M80 (Management), M98 (Executive)
40 hours of leave credits per fiscal year
Name of recipient employee:
Type and number of hours to be donated:
• Total number of hours donated:
Please check here if you would like the recipient to know the hours you are donating.
Please check here if you would prefer to remain anonymous.
I understand that the hours I donate will be tr
ansferred to the employee named above.
Signature: Date:
Bargaining Unit Number:
____________
________________
• Sick Leave hours (for employee illness):
_________________
• Vacation hours (for employee illness or FMLA to care for a family member): ________________
Name of Employee Donating Leave:
click to sign
signature
click to edit
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