USD 379
Staff Request
for Donated Temporary Sick Leave
Date:
I,
request donated temporary sick leave due to the
following situation:
Employee requesting donation: (check one)
1. Certified/Negotiated Agreement
2. Hourly
3. Classified Salaried, salaried – NOT covered under the Negotiated Agreement
Each employee must be approved by the committee/council designated according to the current
Negotiated Agreement and Classified Handbook.
Employee Signature
Date
Principal or Director and/or CCEA members Signature
Date
*****This portion to be completed by District Office staff ONLY. ******
Request approved by:
District Office
Amount of donated leave hours received:
Payroll date
Donor
Date
Hours donated
Hours credited
Approved 2014-2015 school year