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* Sick Leave Pool Enrollment

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* Sick Leave Pool Enrollment
Sick Leave Pool Enrollment
Name:
PID#
Department:
Position Title
ENROLLMENT
*
I hereby donate
accumulated sick leave hours as required for membership as
outlined in the Sick Leave Pool Procedures. I have read and understand the policy and
procedures and agree to membership requirements, including, but not limited to, replenishment
contributions. I agree to the use of my voluntarily donated leave hours according to the
Procedures and understand I cannot reclaim hours donated.
Signed:
*40-hour employees must donate 16 hours.
35-hour employees must donate 14 hours.
168-day contract employees must donate 10.5 hours.
Date:
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