Office of Employee Services
Date
EMPLOYEE CONSENT TO RELEASE NAME FOR
DONATED LEAVE PURPOSES
Department: -Select-
Name:
Employee ID:
Hours Needed:
By signing this statement, you acknowledge that Valley City State University has
the right to disclose your name to eligible donors for donated annual or sick leave
purposes. Reasons for your request for donated leave will NOT be given out.
Signature of Employee
Return form to:
Date
Employee Services
McFarland 211
[email protected]
(701)845-7401
101 College Street SW ♦ Valley City, ND 58072 ♦ 701 845 7401 ♦ fax 701 845 7247 ♦ [email protected]