Mcpr 2001 Appendix K Sick Leave Donor Authorization Form (Page 3 of 3) in pdf

Mcpr 2001 Appendix K Sick Leave Donor Authorization Form Page 3

MCPR, 2001

APPENDIX K, SICK LEAVE DONOR PROGRAM AUTHORIZATION FORM

Sick Leave Donor Program Authorization Form

For use by Department of Finance, Payroll Section only:

Employee’s name: __________________________________

Date received: _________________________________

A full-time employee who donates leave must maintain a sick leave or PTO balance of

80 hours after donation. A part-time employee who works at least 40 hours in a pay

period must maintain a sick leave or PTO balance of 40 hours. A part-time employee

who works less than 40 hours in a pay period must maintain a pro-rated amount of

unused sick leave or PTO after donation.

Employee recipient leave balance:

Annual ____ Sick ____ PTO ____ Personal leave days ____ Compensatory time ____

To be eligible to receive donated sick leave or PTO, an employee must have an

extended illness or injury that causes the employee to be unable to work for more than 7

consecutive calendar days. Employee's last day worked: _________________________

Date employee exhausted all paid leave: ______________________

A full-time employee may receive up to 1040 hours of donated leave in a leave year. A

part-time employee may receive a prorated amount of donated leave. Total leave

donated to employee: ______________________

To be retroactive:

( ) Yes ( ) No

Authorized by: _____________________________ Date: _______________________

K - 3

Mcpr 2001 Appendix K Sick Leave Donor Authorization Form Page 3