SICK LEAVE SICK LEAVE BANKBANK

SICK LEAVE BANK SICK LEAVE BANK PARTICIPATIONPARTICIPATION

Participation, only costs you 3 sick Participation, only costs you 3 sick leave daysleave days

If you are a new employee and have If you are a new employee and have not accrued any sick leave days, not accrued any sick leave days, payroll will deduct them as you earn payroll will deduct them as you earn them. them.

To join, complete the participation To join, complete the participation form found on the intranet. form found on the intranet.

IMPORTANT! You may IMPORTANT! You may onlyonly join join during Open Enrollment from July 1-during Open Enrollment from July 1-Aug. 31. Aug. 31.

PARTICIPATION FORMPARTICIPATION FORM

Madison City SchoolsMadison City Schools Authorization for Sick Leave Bank Participation Authorization for Sick Leave Bank Participation Name: ____________________________________________________Name: ____________________________________________________ Last First MiddleLast First Middle School: ____________________________________________________School: ____________________________________________________ Position: ____________________________________________________Position: ____________________________________________________ ______ ______ I wish to become a member of the Sick Leave Bank and hereby 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 authorize that three (3) days from my personal sick leave account be placed in the Bank. Bank.

______ ______ I wish to become a member of the Sick Leave Bank, but do not have the 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 three (3) days in my account to become a member. I hereby authorize the next three days earned to be placed in the Bank.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 Sick Leave Bank Chairperson Date Date

SICK LEAVE BANKSICK LEAVE BANK

You may resign from the Sick You may resign from the Sick Leave Bank at any timeLeave Bank at any time

You must complete the You must complete the resignation from and send to Dr. resignation from and send to Dr. Jah at West Madison. Jah at West Madison.

RESIGNATION FROM RESIGNATION FROM SICK LEAVE BANKSICK LEAVE BANK

Madison City SchoolsMadison City Schools Notice of Resignation from the Sick Leave BankNotice of Resignation from the Sick Leave Bank Employee ID#___________ Employee ID#___________

Date_________________ Date_________________ Name _________________________________________________Name _________________________________________________ Address________________________________________________________ Address________________________________________________________

Position_____________________Position_____________________ City__________________State________________Zip Code______________ City__________________State________________Zip Code______________

Work Site ___________________Work Site ___________________ I hereby terminate my participation in the Madison City Schools Sick Leave Bank 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 and request that days on deposit in the SLB be returned to my personal sick leave account.leave account.

Signature_____________________________________________________________ Signature_____________________________________________________________ Date____________________________ Date____________________________

Please note:Please note: 1) One (1) copy of this form must be sent to the chairperson of the Sick Leave Bank 1) One (1) copy of this form must be sent to the chairperson of the Sick Leave Bank

Committee, Madison City Schools.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 35758 * (256) 464-8370 * Madison City Schools * 211 Celtic Drive * Madison, AL 35758 * (256) 464-8370 * FAX: (256) 464-8291FAX: (256) 464-8291

Borrowing days from the Sick Borrowing days from the Sick Leave BankLeave Bank

You may borrow up to 15 days You may borrow up to 15 days from the sick leave bank. from the sick leave bank.

Complete the Application to Complete the Application to Borrow Sick Leave Days and Borrow Sick Leave Days and send to Dr. Jah at West send to Dr. Jah at West MadisonMadison

Catastrophic LeaveCatastrophic Leave

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

Catastrophic LeaveCatastrophic Leave

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

Catastrophic LeaveCatastrophic Leave

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

IMPORTANT!!!!IMPORTANT!!!!

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

All Forms are AttachedAll Forms are Attached

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

Join Today!!Join Today!!

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