Sick Leave Bank Donation Form

A sick leave bank has been established for use by regular, full-time employees of the county. Participation in the sick leave bank is voluntary. When an employee donates days to the bank, an equivalent number of days will be deducted from that employee’s accumulated sick leave hours and become the property of the bank.

Donations will not be accepted after 500 hours have been deposited in the sick leave bank.

Name

First Name

Last Name

Email Address

Hours Donated (40 Max)

Which office do you work in?

Department / Office