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Application For Membership
Seminole Community College Sick Leave Pool
I am formally requesting membership in the Seminole Community College sick leave pool. I understand that:
- Upon acceptance for membership, fifteen (15) hours of my personal
sick leave will be deducted from my personal sick leave balance and
contributed to the sick leave pool. I will not have to make an
additional contribution of personal sick leave unless the pool balance
is reduced below 450 hours; in that case, an additional contribution of
7.5 hours will be deducted from my personal sick leave balance.
However, I will not be required to contribute more than 7.5 hours in
any one fiscal year. Further, I understand that this additional
deduction will occur automatically unless I inform the Director of
Human Resources, in writing, within ten work days of the date I am
notified of the need for an additional contribution, of my wish to
discontinue membership.
- A maximum of 225 hours or 30 days of sick leave per fiscal year may
be granted to me from the sick leave pool if I become catastrophically
ill or injured and have exhausted all of my personal sick leave. My
request for leave from the sick leave pool must be made in writing to
the Sick Leave Pool Advisory Board by me or my authorized
representative. I understand that I may request up to an
additional 225 hours (30 days) from the sick leave pool per fiscal year
if required due to the severity of the illness, accident, or injury.
The maximum number of days of leave which may be drawn from the sick
leave pool in any one fiscal year is 60 days.
- Any request to use leave from the sick leave pool is subject to
review by the Human Resources Office and approval of the President. The
Advisory Board may request additional information in connection with a
request for leave, and approval of any request may be conditioned upon
the receipt of medical or other information.
- The Sick Leave Pool Advisory Board is authorized to make
recommendations regarding membership and administration of the sick
leave pool. Any misrepresentation or misuse of the sick leave pool may
subject me to disciplinary action. Personnel information obtained by
the Advisory Board is confidential.
- My participation in the pool is at all times voluntary, and I may
request in writing, at any time, that my membership be canceled. I
understand that any hours of my personal sick leave which have been
contributed to the sick leave pool will remain in the pool upon
cancellation of membership or termination of employment.
Please complete the following:
Name:
Last:
First:
M.I.__
Social Security
Number:________________________________________
Campus
Address:
Department:_____________
Phone No./Work:_______________ ___Home
Phone:________________
Employee's
Signature:
Date:_______________
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To be completed by the Human Resources office.
Your application is:
_____Approved. I certify that, as of ____/____/____, the
above individual has ______hours of sick leave and has been employed
with Seminole Community College for at least one year and that
_____sick leave hours have been deducted from his or her balance and
contributed to Seminole Community College's sick leave pool.
_____Disapproved. Your application is disapproved because:
_______________________________________________________________________
_______________________________________________________________________
_______________________________________
_____________________
Director,
Human
Resources
Date
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