SICK LEAVE BANK

SICK LEAVE BANK PARTICIPATION Participation, only costs you 3 sick leave days Participation, only costs you 3 sick leave days If you are a new employee and have not accrued any sick leave days, payroll will deduct them as you earn them. If you are a new employee and have not accrued any sick leave days, payroll will deduct them as you earn them. To join, complete the participation form found on the intranet. To join, complete the participation form found on the intranet. IMPORTANT! You may only join during Open Enrollment from July 1- Aug. 31. IMPORTANT! You may only join during Open Enrollment from July 1- Aug. 31.

PARTICIPATION FORM Madison City Schools Madison City Schools Authorization for Sick Leave Bank Participation Authorization for Sick Leave Bank Participation Name: ____________________________________________________ Name: ____________________________________________________ Last First Middle Last First Middle School: ____________________________________________________ School: ____________________________________________________ Position: ____________________________________________________ Position: ____________________________________________________ ______ I wish to become a member of the Sick Leave Bank and hereby authorize that three (3) days from my personal sick leave account be placed in the Bank. ______ I wish to become a member of the Sick Leave Bank and hereby authorize that three (3) days from my personal sick leave account be placed in the Bank. ______ I wish to become a member of the Sick Leave Bank, but do not have the three (3) days in my account to become a member. I hereby authorize the next three days earned to be placed in the Bank. ______ I wish to become a member of the Sick Leave Bank, but do not have the three (3) days in my account to become a member. I hereby authorize the next three days earned to be placed in the Bank. _______________________________________________ _________________________________ _______________________________________________ _________________________________ Signature Date Signature Date (for office use only) (for office use only) APPROVAL: APPROVAL: _____________________________ _______________________ _____________________________ _______________________ Sick Leave Bank Chairperson Date Sick Leave Bank Chairperson Date

SICK LEAVE BANK You may resign from the Sick Leave Bank at any time You may resign from the Sick Leave Bank at any time You must complete the resignation from and send to Dr. Jah at West Madison. You must complete the resignation from and send to Dr. Jah at West Madison.

RESIGNATION FROM SICK LEAVE BANK Madison City Schools Madison City Schools Notice of Resignation from the Sick Leave Bank Notice of Resignation from the Sick Leave Bank Employee ID#___________ Date_________________ Employee ID#___________ Date_________________ Name _________________________________________________ Name _________________________________________________ Address________________________________________________________ Position_____________________ Address________________________________________________________ Position_____________________ City__________________State________________Zip Code______________ Work Site ___________________ City__________________State________________Zip Code______________ Work Site ___________________ I hereby terminate my participation in the Madison City Schools Sick Leave Bank and request that days on deposit in the SLB be returned to my personal sick leave account. I hereby terminate my participation in the Madison City Schools Sick Leave Bank and request that days on deposit in the SLB be returned to my personal sick leave account. Signature_____________________________________________________________ Date____________________________ Signature_____________________________________________________________ Date____________________________ Please note: Please note: 1) One (1) copy of this form must be sent to the chairperson of the Sick Leave Bank Committee, Madison City Schools. 1) One (1) copy of this form must be sent to the chairperson of the Sick Leave Bank Committee, Madison City Schools. 2) One (1) copy of this form must be sent to the Madison City Schools Payroll Office. 2) One (1) copy of this form must be sent to the Madison City Schools Payroll Office. 3) One (1) copy should be retained for the employee's records. 3) One (1) copy should be retained for the employee's records. _______________________________________________________________ ______________________________ _______________________________________________________________ ______________________________ Madison City Schools * 211 Celtic Drive * Madison, AL * (256) * FAX: (256) Madison City Schools * 211 Celtic Drive * Madison, AL * (256) * FAX: (256)

Borrowing days from the Sick Leave Bank You may borrow up to 15 days from the sick leave bank. You may borrow up to 15 days from the sick leave bank. Complete the Application to Borrow Sick Leave Days and send to Dr. Jah at West Madison Complete the Application to Borrow Sick Leave Days and send to Dr. Jah at West Madison

Catastrophic Leave You may apply for Catastrophic Leave after you have exhausted all forms of leave; sick leave, personal leave, vacation leave and have previously borrowed 15 days from the Sick Leave Bank. You may apply for Catastrophic Leave after you have exhausted all forms of leave; sick leave, personal leave, vacation leave and have previously borrowed 15 days from the Sick Leave Bank.

Catastrophic Leave When you apply for catastrophic leave you must complete the form and return the form and doctor’s documentation to Dr. Jah at West Madison. When you apply for catastrophic leave you must complete the form and return the form and doctor’s documentation to Dr. Jah at West Madison.

Catastrophic Leave When you are approved for Catastrophic Leave employees from Madison City and other school systems who are members of the Sick Leave Bank may donate days to you. When you are approved for Catastrophic Leave employees from Madison City and other school systems who are members of the Sick Leave Bank may donate days to you.

IMPORTANT!!!! You must be a member of the Sick Leave Bank to donate days to an individual!!!! You must be a member of the Sick Leave Bank to donate days to an individual!!!!

All Forms are Attached (Once you have completed the form, make sure you have the appropriate documentation then ecopy/ them to me (djah) or send them in the interoffice mail to Daphne Jah at West Madison. (Once you have completed the form, make sure you have the appropriate documentation then ecopy/ them to me (djah) or send them in the interoffice mail to Daphne Jah at West Madison.

Join Today!! Join Today!! Open Enrollment is from July 1-August 31! Open Enrollment is from July 1-August 31!