SICK LEAVE BANK REQUEST FORM. Employee’s Name I am requesting number of days from the sick leave bank. The reason I am requesting sick leave is:
SICK LEAVE BANK REQUEST FORM. Employee Name: Date: Number of Days Requested: Total Number of Bank Days Used to Date Guidelines: Written application submitted by employee. Physicians statement stating nature, length of disability, prognosis. FMLA form 4358 submitted if applicable. Employee is qualified member of sick bank. Use is for personal illness only. All employee sick/personal leave days must be used before approval, or granted retroactively. Majority vote of committee members constitutes decision. Maximum number of days granted shall not exceed 20 working days per school year. At least 75 days shall be left in the sick bank. Part-time teachers who donate to the bank shall receive prorated benefits. Days must be paid back at rate of 3 per year. Request granted for days. Sick Days will be retroactive after exhaustion of _ sick days accumulated by employee. Request denied. President of Association Signature Superintendent Signature Committee Member Signature Board Member Signature Committee Member Signature Approved Agreement Between the Flat Rock-Hawcreek Board of School Trustees and the Flat Rock-Hawcreek Teachers’ Association For the 2010-2011 school year May 4, 2010 Approved Agreement: • Accept master contract language for 2010-2011, 2011-2012, and 2012-2013. • No language changes for 2009-2010 and 2010-2011 from either party. • 0% increase to the salary schedule for the 2009-2010 and 2010-2011 school years. • Renewal of the current insurance plans for May 1, 2010 – April 30, 2011 with no increase in medical premiums for both side and no increase in administrative costs for the plan. • The Board contributes 1% of the teacher’s base salary to the 401 (a) retirement savings for the 2009-2010 school year. The Board contributes ½% of the teacher’s base salary to the 401(a) retirement savings for the 2010-2011 school year. • A memorandum of agreement between FHTA and the Board will be written before September 1, 2010 to address parent/teacher conferences for the 2010-2011 and following school years. Reopeners • 2011-2012 and 2012-2013 salaries, benefits, ECA, two language items per party Approved by the Flat Rock-Hawcreek Board of School Trustees May 4, 2010. Flat Rock-Hawcreek Board of School Trustees Flat Rock-Hawcreek Teachers’ Association _____________________________________ ____________________________________ Xx. Xxxxxx Xxxxxx, President of Board of School Trustees Mrs. Xxxxxx Xxxxxxxx, Co-President of the Association _____________________________________ _____________________...
SICK LEAVE BANK REQUEST FORM. The sick leave bank has been established for use by eligible unit members whose earned sick and personal leave accumulation has been exhausted from a prolonged illness, medically required surgery, or injury and documented in writing by a physician. The application must be submitted in original format no earlier than ten (10) school days prior to a unit member exhausting all of her own personal sick leave days. Name: School/Location: Date of Request: Date sick and personal leave is exhausted: Number of days requested: Reason for request: Attach certification from a health care provider that the unit member’s condition prevents the unit member from performing her regular duties. The administration reserves the right to verify the authenticity of any required documentation. I am aware that if additional days are required, I must submit a new application as well as provide additional documentation from the health care provider. Unit members will not receive compensation without the required documentation. Payment cannot be processed until all required approvals are submitted to Payroll. Unit Member Signature Date Any grant of sick leave by the Sick Leave Bank Committee to an eligible member shall not exceed twenty
