"Sick Leave Bank Donation Form for Managerial and Confidential Employees" - Vermont

Sick Leave Bank Donation Form for Managerial and Confidential Employees is a legal document that was released by the Vermont Department of Human Resources - a government authority operating within Vermont.

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2021 Sick Leave Bank Donation Form
For
Managerial and Confidential Employees
Donations may be made at any time during the year.
Name: _________________________________________ Employee Number: ____________
Department: __________________________________________________________________
I request transfer of _________ hours of personal leave and/or ________ hours of annual
leave to the Sick Leave Bank for Managerial and Confidential Employees. I understand that I
may donate up to 100% of my personal leave balance. In addition, I may donate up to 50% of my
annual leave balance so long as I retain at least 80 hours of annual leave.
My leave balances, after the donations are subtracted, are:
Personal Leave: ______________________
Annual Leave: _________________________
• Employee Signature: ___________________________________ Date: _______________
• Human Resources
Administrator Signature: ________________________________ Date: _______________
(or designee of the appointing authority)
Thank you for making a difference!
Please print this form, complete it, and forward it to your Human Resources Administrator for their
signature and date. You may contact your Human Resources Administrator with any questions
regarding donating time to the Bank.
Human Resources Administrators can e-mail the form to: Anne.Carver@vermont.gov
Or, Human Resources Administrators can mail to: Human Resources, Attn: Anne Carver,
th
120 State Street, 5
Floor, Montpelier, VT 05620-2505
PLEASE NOTE: Donation forms must be received by December 31, 2021
2021 Sick Leave Bank Donation Form
For
Managerial and Confidential Employees
Donations may be made at any time during the year.
Name: _________________________________________ Employee Number: ____________
Department: __________________________________________________________________
I request transfer of _________ hours of personal leave and/or ________ hours of annual
leave to the Sick Leave Bank for Managerial and Confidential Employees. I understand that I
may donate up to 100% of my personal leave balance. In addition, I may donate up to 50% of my
annual leave balance so long as I retain at least 80 hours of annual leave.
My leave balances, after the donations are subtracted, are:
Personal Leave: ______________________
Annual Leave: _________________________
• Employee Signature: ___________________________________ Date: _______________
• Human Resources
Administrator Signature: ________________________________ Date: _______________
(or designee of the appointing authority)
Thank you for making a difference!
Please print this form, complete it, and forward it to your Human Resources Administrator for their
signature and date. You may contact your Human Resources Administrator with any questions
regarding donating time to the Bank.
Human Resources Administrators can e-mail the form to: Anne.Carver@vermont.gov
Or, Human Resources Administrators can mail to: Human Resources, Attn: Anne Carver,
th
120 State Street, 5
Floor, Montpelier, VT 05620-2505
PLEASE NOTE: Donation forms must be received by December 31, 2021