Form for Non-CEA Affiliated Staff

Form for Non-CEA Affiliated Staff
I would like to participate in the Sick Leave Bank Pool and I am donating to the pool:
Choose the number of days you wish to donate
Choose the number of days you wish to donate
Choose the number of days you wish to donate
Please add the sick, personal and vacation days you wish to donate. Enter the total number of days here.
I understand the following:

(1) My accrued balance will be decreased by the amount of the donation stated above.
(2) This contribution to the Sick Leave Bank is voluntary.
(3) This donation cannot be reversed. Once I make my donation, I am no longer entitled to use the donated day(s).
(4) This donation does not guarantee that I will be granted use of the sick bank in the future.
(5) To remain eligible for the sick bank, I must donate at least one day each school year.
By checking, I agree, I confirm that I have read and understand the rules outlined above. By checking "I agree" I submit my days to the sick bank.
I agree
I do not agree
Please enter characters in the image above. Letters are case-sensitive.


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