Motlow State Community College
SICK LEAVE BANK ENROLLMENT FORM
Name SSN or Banner ID
Position Title
REGULAR FULL‐TIME EMPLOYEE
REGULAR PART‐TIME EMPLOYEE
A copy of the sick leave bank plan and regulations have been made available to me. I am aware
of the contents and that any assessments made of my accrued sick leave by the trustees of the
bank shall be nonrefundable and nontransferable.
Initial enrollment assessment will be 22.5 hours or three (3) days for full‐time employees and
hours equal to three (3) regular work days for part‐time employees.
This assessment is made in accordance with the statutory provisions and institutional or area
school regulations governing the Sick Leave Bank and is based upon projected potential need of
the Bank’s membership. Once authorized by you, this assessment of hours is nonrefundable
and nontransferable.
Date:
Signature
This form must be forwarded to the chairperson of the Non-Faculty Sick Leave Bank when completed and
no later than November 30.
Chairperson’s signature:
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signature
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