Common use of EMPLOYEE’S CERTIFICATION Clause in Contracts

EMPLOYEE’S CERTIFICATION. I certify that all of the statements made by me in this application for paid benefits by my publicly funded employer are true and complete to the best of my knowledge and belief and that such statements have been honestly presented. I understand that providing any false or misleading information on this application shall be fully sufficient grounds to refuse to grant sick bank days to me, or, if such days have already been provided to me, to discipline me in accordance with the collective bargaining agreement and/or Maine law. Signature: Print Name: Date: APPENDIX C: ASSOCIATION SICK LEAVE BANK CERTIFICATION FORM CERTIFICATION OF HEALTH CARE PROVIDER FOR CATASTROPHIC ILLNESS (This form should be used only if there is not a current FMLA/FML medical certification on file covering the request for sick leave bank.)

EMPLOYEE’S CERTIFICATION. I certify that all of the statements made by me in this application for paid benefits by my publicly funded employer are true and complete to the best of my knowledge and belief and that such statements have been honestly presented. I understand that providing any false or misleading information on this application shall be fully sufficient grounds to refuse to grant sick bank days to me, or, if such days have already been provided to me, to discipline me in accordance with the collective bargaining agreement and/or Maine law. Signature: Print Name: Date: APPENDIX CE: ASSOCIATION SICK LEAVE BANK CERTIFICATION FORM CERTIFICATION‌ CERTIFICATION OF HEALTH CARE PROVIDER FOR CATASTROPHIC ILLNESS (This form should be used only if there is not a current FMLA/FML medical certification on file covering the request for sick leave bank.)

EMPLOYEE’S CERTIFICATION. I certify that all of the statements made by me in this application for paid benefits by my publicly funded employer are true and complete to the best of my knowledge and belief and that such statements have been honestly presented. I understand that providing any false or misleading information on this application shall be fully sufficient grounds to refuse to grant sick bank days to me, or, if such days have already been provided to me, to discipline me in accordance with the collective bargaining agreement and/or Maine law. Signature: Print Name: Date: APPENDIX C: ASSOCIATION SICK LEAVE BANK CERTIFICATION FORM FORM‌ CERTIFICATION OF HEALTH CARE PROVIDER FOR CATASTROPHIC ILLNESS (This form should be used only if there is not a current FMLA/FML medical certification on file covering the request for sick leave bank.)

EMPLOYEE’S CERTIFICATION. I certify that all of the statements made by me in this application for paid benefits by my publicly funded employer are true and complete to the best of my knowledge and belief and that such statements have been honestly presented. I understand that providing any false or misleading information on this application shall be fully sufficient grounds to refuse to grant sick bank days to me, or, if such days have already been provided to me, to discipline me in accordance with the collective bargaining agreement and/or Maine law. Signature: Print Name: Date: APPENDIX CE: ASSOCIATION SICK LEAVE BANK CERTIFICATION FORM CERTIFICATION‌‌ CERTIFICATION OF HEALTH CARE PROVIDER FOR CATASTROPHIC ILLNESS (This form should be used only if there is not a current FMLA/FML medical certification on file covering the request for sick leave bank.)