SICK LEAVE BANK REQUEST FORM Sample Clauses

The Sick Leave Bank Request Form clause establishes the procedure for employees to formally request additional paid leave from a collective pool of sick leave hours, known as the Sick Leave Bank. Typically, this clause outlines the eligibility criteria, the required documentation, and the steps employees must follow to submit their request, such as providing medical certification or detailing the nature of their illness. Its core practical function is to ensure a standardized and fair process for accessing shared sick leave resources, thereby supporting employees facing extended illness while maintaining administrative clarity and consistency.
SICK LEAVE BANK REQUEST FORM. Employee’s Name I am requesting number of days from the sick leave bank. The reason I am requesting sick leave is:
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SICK LEAVE BANK REQUEST FORM. The sick leave bank has been established for use by eligible unit members whose earned sick and personal leave accumulation has been exhausted from a prolonged illness, medically required surgery, or injury and documented in writing by a physician. The application must be submitted in original format no earlier than ten (10) school days prior to a unit member exhausting all of her own personal sick leave days. Name: School/Location: Date of Request: Date sick and personal leave is exhausted: Number of days requested: Reason for request: Attach certification from a health care provider that the unit member’s condition prevents the unit member from performing her regular duties. Unit Member Signature Date Any grant of sick leave by the Sick Leave Bank Committee to an eligible member shall not exceed twenty
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SICK LEAVE BANK REQUEST FORM. The sick leave bank has been established for use by eligible unit members whose earned sick and personal leave accumulation has been exhausted from a prolonged illness, medically required surgery, or injury and documented in writing by a physician. The application must be submitted in original format no earlier than ten (10) school days prior to a unit member exhausting all of their own personal sick leave days. The Sick Leave Bank Committee shall respond to all applications no later than ten (10) school days from receipt of completed application and all required documentation. Name: School/Location: Date of Request: Number of Days Requested: Date sick and personal leave is exhausted: Reason for Request: Unit Member Signature & Date Any grant of sick leave by the Sick Leave Bank Committee to an eligible member shall not exceed twenty (20) days. Upon completion of any grant of sick leave days by the Sick Leave Bank Committee, additional days may be granted upon demonstration of continued eligibility by the applicant. No unit member shall be granted more than one hundred eighty two (182) sick leave days for the same illness by the committee. Approved: #of Days Not Approved: Name School/Location Pursuant to ARTICLE X, Extended Leaves of Absence, I hereby request the following leave:
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SICK LEAVE BANK REQUEST FORM. Employee Name: Date:
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Related to SICK LEAVE BANK REQUEST FORM

  • Sick Leave Bank A. All teachers on active duty in ▇▇▇▇▇▇▇▇▇ County are eligible to contribute to a sick leave bank. Contributors will be permitted to use the bank for payment of prolonged, catastrophic, incapacitating personal illness, injury or quarantine of the teacher during the regularly scheduled duty days, which illness, injury or quarantine is not likely to permanently disable the teacher. B. Annual rates of contribution shall be as determined by the Association and certified to the Superintendent prior to July 1 of each year. ▇▇▇▇ leave properly authorized to the bank for contribution will not be returned if the member effects cancellation. Cancellation, on the proper form, may be elected at any time and the member shall not be eligible to use the bank as of the effective cancellation date. C. Teachers may join the Sick Leave Bank between July 1 and October 1. Members returning from extended leave will be permitted to contribute to the bank within thirty (30) days of return to work. New teachers will be permitted to join the bank within thirty (30) days after employment begins. D. Members of the sick leave bank are eligible to access the bank on the first scheduled duty day. The approval committee, upon receipt of a request for days, shall immediately forward to the Human Resources Division a copy of said request. The Human Resources Division shall within five (5) days inform the committee in writing of any concerns or information that may have a bearing on the committee's decision. The maximum number of sick days that can be granted in connection with any single occurrence of an illness or complications arising from such an occurrence will be equal to one (1) work year. If a member is still unable to return to work after exhaustion of all bank benefits, unpaid leave shall be made available in accordance with Article XXVIII. In lieu of said unpaid leave, the member, at his/her option, may apply for disability retirement benefits; however, in the event that a member who has been retired due to disability desires to return to active duty upon the expiration of such disability retirement benefits, the Board agrees to assign the member to a position in accordance with Article XXVIII, Section I. In no case will the granting of leave from the bank cause a member to receive more than his/her annual salary. E. Members must use all accumulated sick leave before applying for leave from the bank. Application for use of the bank shall be made on the required form and submitted to the approval committee. ▇. ▇▇ approval committee, appointed by the president of the Association, shall have the responsibility of receiving requests, verifying the validity of requests, recommending approval or denial of the request and communicating its decision to the member and the Human Resources Division. The committee shall develop its rules of procedures and shall give wide distribution of said rules upon approval of the executive committee of the Association and the Superintendent. G. Upon receipt of the decision of the approval committee, the Human Resources Division shall verify that the request is within the limits of the bank balance, that the applicant's accumulated sick leave has been exhausted and that the applicant's illness is prolonged, catastrophic, incapacitating and personal. The decision of the approval committee shall be approved by the Human Resources Division unless the decision of the approval committee is arbitrary or capricious. Upon issuance of such approval, the Human Resources Division shall forward the sick leave bank grant to the payroll office. H. Any disputes arising from this Article shall be expedited through the grievance procedure provided herein, except that the American Arbitration Association's expedited labor arbitration rules shall govern the proceedings. I. If a member does not use all of the days granted from the bank, the unused sick leave bank days will be returned to the bank. J. Non-FCTA members shall be charged an administrative fee of $200 for each sick leave bank request processed.

  • Leave Bank 1. A sick leave bank shall be maintained within the District. The purpose of the Leave Bank is to provide a bank of sick leave days from which staff may draw in cases of extended absences due to illness or injury which renders the staff member incapable of working. 2. The bank was funded initially by a mandatory contribution from each employee of one (1) day from that employee’s individual sick leave account, as well as a 100-day contribution from the school district. 3. The sick leave bank shall be administered by the Superintendent and the Association President(s). 4. For new employees, a mandatory contribution of one (1) day shall be made by them on the day on which their initial individual leave time is allotted to them. Leave days in the bank will carry over from year to year. The bank will contain a maximum of 500 days and a minimum of 250 days. Employees who leave the district, excluding staff who retire under PERA, shall contribute any remaining accrued days to the leave bank. At such time as the bank drops below 250 days, an additional contribution of one (1) day per employee shall be made to replenish the bank’s days at the beginning of the school year 5. Persons who have used all of their leave entitlement shall be eligible to draw from the leave bank under the following condition: a. Only when under a doctor’s care. b. For each first day granted from the leave bank per occurrence the employee shall be docked the current substitute pay. c. For a recurring illness or a medical condition that requires periodic and consistent medical treatment of a severe disablement, Sick Leave Bank Days (in increments of half days) may be granted for all absences resulting from these conditions d. Any individual who is absent as a result of a medically diagnosed catastrophic illness or injury may access the bank for up to and including sixty (60) additional days. Utilization of these days shall require the submission of a new Leave Bank Application to the bank. 6. An individual who meets the requirements stated above can use a total of no more than thirty (30) days per school year from the leave bank. 7. An individual may request days from the Leave Bank any time prior to but within thirty (30) calendar days after the individual returns to work. Applications submitted at a time outside these limits will not be considered by the Superintendent and Association President(s). The request must be submitted to the Superintendent office using the Leave Bank Application. The application can be located in the appendix of this agreement. Upon receipt of the application the Superintendent shall forward the request to the Association President(s). The Superintendent and Association President(s) shall meet, within ten (10) days to consider such request. Within five (5) days following said meeting, the applicant shall be notified, in writing, of the status of the request. 8. Any individual who has accessed the leave bank and resigns their position in the same contract year will be docked their daily rate of pay for each day used from the bank. 9. Elective treatment or surgery is defined as a condition diagnosed by a Doctor that admission sometime in the future is acceptable for a condition causing minimal or no pain, dysfunction or disability and can be safely postponed until non-contract time. Such conditions shall not qualify for Leave Bank Days. 10. The District is liable only for the total number days in the leave bank.

  • Sick Leave Bank Committee The Sick Leave Bank Committee shall consist of two (2) members appointed by the Chairperson of the School Committee, and two (2) members appointed by the bargaining unit chairperson. The Sick Leave Bank Committee shall govern all phases of the Sick Leave Bank, including the option to accept or reject applications for sick leave.

  • Extended Sick Leave When sick leave extends for more than 25 consecutive working days, the appointing authority shall initiate the following procedure:

  • Notice of Conversion/Continuation a Notice of Conversion/Continuation to be provided by Borrower Agent to request a conversion or continuation of any Loans as LIBOR Loans, in form satisfactory to Agent.