Gadsden State Community Collegeapplicationforloan

G/1.5-A

GADSDEN STATE COMMUNITY COLLEGEAPPLICATIONFORLOAN

G/1.5-A

DaysfromtheSickLeaveBankshallnotbeawardeduntilallaccumulatedsickleavedaysinthepersonalaccounthavebeenexhausted.AllloansaresubjecttotheapprovaloftheSickLeaveBankCommittee.

PLEASEPRINT

EMPLOYEE’SNAMESOCIALSECURITYNUMBER

NAMEOFIMMEDIATESUPERVISOR

************************************************************************NumberofDaysRequestedfromtheSickLeaveBank

EffectiveDateofRequest:

StartingDate:EndingDate: ReasonforLeave:

************************************************************************

OriginalRequestDaysAwardedbySLBRequestforExtensionofLoan

SignatureofSickLeaveBankCommitteeChairpersonDate

************************************************************************

CopySenttoPayroll OfficeCopySenttoApplicant

************************************************************************

Sendthisapplicationto:

Chairperson,SickLeaveBankCommitteeincareof

GadsdenStateCommunityCollegePayrollOffice

G/1.5-A

CATASTROPHICSICK LEAVETRANSFER AUTHORIZATION

DONATINGEmployeeInformation(PLEASEPRINT ORTYPEFORM)

1. EmployeeName:
2. EmployeeAddress:
3. EmployeeTelephone(s):
4. Employer:

BENEFICIARY EmployeeInformation

5. EmployeeName:
6. Employer:

Certification ofDONATING Employee

8. IcertifythatIherebydonatetheabovenotednumberofmysickleave days tothe beneficiaryemployee listedabove. Myemployerhas mypermission totransfertheindicatednumberofsickleavedays totheemployerofthebeneficiaryforhisor herusedue toa catastrophicillness/injuryas defined byAct93-753.Itis myunderstandingthatmysickleavebalancewill be reducedbythe specifiednumberofdayshereonandthatthedonateddayswillnotbereturnedto me.
DonatingEmployee’sSignature: / Date:
Witness: / Date:

Certification ofDONATING Employer

9. Iherebycertifythatthedonatingemployee’sinformationlistedabove is correcttothebestofmyknowledge.
AuthorizedSignature: / Date:
Title:

ReceiptofBENEFICIARYEmployer

10.The abovenotednumberofsickleavedayshasbeencreditedtothesickleaveaccountofthebeneficiaryemployee. (Pleasegive a copyofthisformto the beneficiaryemployee.)
AuthorizedSignature: / Date:
Title:

Revised 03-10