CITY OF OAKLAND
SICK LEAVE ADVANCE Employee Request and Agreement (COVID-19)
Name:
________________
(Please print)
(Employee ID Number)
(Contact Phone)
Job Classification: Department:
Due to the COVID-19, I request a Sick Leave Advance (not to exceed 75, 80 or 96 hours, depending on regular
schedule) to cover my leave from:
Start Date: ________________________ End Date: ________________________
Number of hours requested: _____________
At its discretion, the Department may determine the type and how many leave hours to advance, which will be
prorated for employees who do not work a full-time schedule.
I am requesting leave for the following circumstance related to COVID-19:
___ To care for myself
___ To care for a member of my family as defined by the applicable labor agreement
___ To provide childcare due to school closure from COVID-19
I have read and understand the SICK LEAVE ADVANCE PROCEDURE. I understand that any sick leave
advanced is a loan of time not yet earned that I am required to repay by forgoing accruing sick leave as it is
earned, until such time as I have repaid the entire amount advanced. I further understand that as a
condition of receiving a leave advance, I agree that if I separate from employment before fully repaying the
leave advance, I will repay the remaining unpaid balance, if any:
at the time of separation; I hereby voluntarily agree and authorize the City to deduct any
remaining balance due from my final pay or other compensation due to me at separation, and
if the amount due to me upon separation does not fully repay the remaining unpaid
balance, I agree to repay the full remaining amount directly within 60 days of receipt of a
demand for repayment.
Should I fail to repay any sick Leave advanced to me when due, I understand and agree that the City
will take appropriate action to collect on the unpaid balance, which may subject me to additional
costs and interest as allowed by law.
Signature: Date:
Return this completed from with your Request for Leave and Leave Protections form to your supervisor,
manager, or department’s Single Point of Contact (SPOC).
Department SPOC/Designee: Approved (Accrued Leave Exhausted) Disapprove (Leave Balances)
Name: ____________________________________ Signature: _____________________________ Date: _________
Human Resources Director/Designee: Approved (Accrued Leave Exhausted) Disapprove (Leave Balances)
Name: ____________________________________ Signature: _____________________________ Date:__________
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