Caes Uga - Shared Leave Solicitation Form printable pdf download

Caes Uga - Shared Leave Solicitation Form

Shared Leave Solicitation Form

Once University Human Resources has approved you for Shared Leave,

please provide the following information so that CAES Employee Benefits

can solicit leave for you.

Name _______________________________

Signature ____________________________

Department ___________________________

Areas you would like to solicit leave

_____ CAES (whole college)

_____ Extension District/ Department

_____ Research Department/ Unit

_____Teaching

Please note that per HIPPA regulations, we will not reveal any specifics of

your illness, only that you have been approved for shared leave.

The statement that will be sent out requesting Shared Leave will be stated as

follows:

Employee’s Name, Dept in CAES, has been approved to be a shared

leave recipient. If you would like to donate leave to Employee’s Name,

please complete the donor form

( )

and send to UGA Human Resources, ATTN: Shared Leave Program,

Human Resources Building, 215 S. Jackson St., Athens, GA 30602.

Please note that this employee will only be able to use donated leave as sick leave.

Mail form to: Whitney Gaughan

HR Specialist III

209 Conner Hall

Athens, GA 30602

Updated 4/10/2009

Caes Uga - Shared Leave Solicitation Form