Request For Formal Leave Of Absence Form - California State University Fullerton Page 18

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PROCEDURES FOR CATASTROPHIC
LEAVE DONATION PROGRAM
Employee's Name
EMPL ID
EMPL RCD#
Department
Date
I hereby agree to allow Academic Affairs and/or Human Resources to notify the representative I designated on the Request for Solicitation
of Donated Leave Credits (HR 500) form, my department, and Payroll of the approval or denial of my request to receive donated leave
credits. I understand that my representative must obtain from me my permission before publicizing or soliciting donations of leave credits
on my behalf. I hereby authorize Academic Affairs, Human Resources, and Payroll to have discussions concerning this request with my
representative as needed.
In addition, I agree to hold harmless the Trustees of the California State University and California State University, Fullerton and its
employees from liability concerning all aspects of my request for solicitation of donated leave credits for myself or family member.
Date
Signature of Employee/Employee's Designee

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Parent category: Business