Common use of Sick Leave Bank Program Clause in Contracts

Sick Leave Bank Program. SUMTER COUNTY SCHOOLS Please return the completed form to the Sumter County Schools, Finance Department. This is to certify that this patient has suffered a catastrophic personal injury or illness and is anticipated to be incapacitated and unable to return to work at this time. Physician’s Diagnosis/Nature of Illness or Injury: Approximate Date of Onset of Illness/Injury Estimated Date of Return to Work Month Day Year Month Day Year Physician’s Date Telephone Number Please return this form to the Sumter County Schools Finance Department when completed. Employee Name School or Cost Center Social Security Number Position: Teacher Non-Instructional Administrative, Supervisory, Confidential

Sick Leave Bank Program. SUMTER COUNTY SCHOOLS Please return the completed form to the Sumter County Schools, Finance Department. This is to certify that this patient has suffered a catastrophic personal injury or illness and is anticipated to be incapacitated and unable to return to work at this time. Physician’s Diagnosis/Nature of Illness or Injury: Approximate Date of Onset of Illness/Injury Estimated Date of Return to Work Month Day Year Month Day Year Physician’s Address Physician’s Signature St. or Box # City State Zip Code Date Telephone Number Please return this form to the Sumter County Schools Finance Department when completed. Employee Name School or Cost Center Social Security Number Position: Teacher Non-Instructional Administrative, Supervisory, Confidential