SICK LEAVE BANK

1. SICK LEAVE BANK

2. SICK LEAVE BANK PARTICIPATION • 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. • To join, complete the participation form found on the intranet. • IMPORTANT! You may only join during Open Enrollment from July 1-Aug. 31.

3. PARTICIPATION FORM • Madison City Schools • Authorization for Sick Leave Bank Participation • Name: ____________________________________________________ • Last First Middle • School: ____________________________________________________ • 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, 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 • ------------------------------------------------------------------------------------------------------------------------------- • (for office use only) • APPROVAL: • _____________________________ _______________________ • Sick Leave Bank Chairperson Date

4. SICK LEAVE BANK • 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.

5. RESIGNATION FROM SICK LEAVE BANK • Madison City Schools • Notice of Resignation from the Sick Leave Bank • Employee ID#___________ Date_________________ • Name _________________________________________________ • Address________________________________________________________ Position_____________________ • 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. • Signature_____________________________________________________________ Date____________________________ • Please note: • 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. • 3) One (1) copy should be retained for the employee's records. • _____________________________________________________________________________________________ • Madison City Schools * 211 Celtic Drive * Madison, AL 35758 * (256) 464-8370 * FAX: (256) 464-8291

6. Borrowing 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

7. 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.

8. 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.

9. 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.

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

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

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