Attachment 2 "Interagency Sick Leave Transfer - Request to Donate" - Florida

What Is Attachment 2?

This is a legal form that was released by the Florida Department of Juvenile Justice - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 1, 2018;
  • The latest edition provided by the Florida Department of Juvenile Justice;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Attachment 2 by clicking the link below or browse more documents and templates provided by the Florida Department of Juvenile Justice.

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Download Attachment 2 "Interagency Sick Leave Transfer - Request to Donate" - Florida

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ATTACHMENT 2
State of Florida
INTERAGENCY SICK LEAVE TRANSFER
REQUEST TO DONATE
Part I - Request to Donate Sick Leave Hours - Donor Information
I certify that I have read and understand the requirements and provisions of 60L-34.0042(5), F.A.C., and that I am eligible and willing to
permanently
donate my personal sick leave credits as specified below. I further understand that the donated sick leave credits will be
deducted
from my sick leave balance at the end of the pay period and if unused, will be returned.
Print Name:
People First Employee ID#:
Agency/Division/Bureau or District/Region/Institution:
Work Telephone Number: (
)
I authorize my employer to transfer
hours of sick leave to the following recipient (minimum of 8 hours).
I certify that I am related to the recipient by birth, marriage or other legal relationship, as specified in 60L-34.0042(5)(b), F.A.C., (spouse,
parents, grandparents, brothers, sisters, children and grandchildren of either the employee or the spouse).
Signature
Date
RECIPIENT INFORMATION
Recipient's Name:
Class Title (if known):
Agency/Division/Bureau or District/Region/Institution:
People First Employee ID # (if known):
Part II - For Personnel Office(s) Use
Recipient's Agency
Donor's Agency
Date:
/ /
Date:
/ /
Send To:
Send To:
Sick Leave Transfer (SLT) Plan Administrator (SLT)
Sick Leave Transfer (SLT) Plan Administrator
Personnel Office/Human Resources
Personnel Office/Human Resources
Department of
Department of
Telephone:
Telephone:
Fax:
Fax:
Hours Credited:
PPE:
/ /
Hours Charged:
PPE:
/ /
Hours Credited:
PPE:
/ /
Approved
Disapproved
Hours Credited:
PPE:
/ /
SLT Administrator's Signature: _____________________
Approved Per Criteria
Disapproved Per Criteria Print SLT Administrator's Name:
SLT Administrator's Signature: ______________________
To send unused sick leave back to donor,
complete the reverse side of this form.
Print SLT Administrator Name:
DMS-SLDONATE Rev. 12/05 - DJJ Rev. 6/18
ATTACHMENT 2
State of Florida
INTERAGENCY SICK LEAVE TRANSFER
REQUEST TO DONATE
Part I - Request to Donate Sick Leave Hours - Donor Information
I certify that I have read and understand the requirements and provisions of 60L-34.0042(5), F.A.C., and that I am eligible and willing to
permanently
donate my personal sick leave credits as specified below. I further understand that the donated sick leave credits will be
deducted
from my sick leave balance at the end of the pay period and if unused, will be returned.
Print Name:
People First Employee ID#:
Agency/Division/Bureau or District/Region/Institution:
Work Telephone Number: (
)
I authorize my employer to transfer
hours of sick leave to the following recipient (minimum of 8 hours).
I certify that I am related to the recipient by birth, marriage or other legal relationship, as specified in 60L-34.0042(5)(b), F.A.C., (spouse,
parents, grandparents, brothers, sisters, children and grandchildren of either the employee or the spouse).
Signature
Date
RECIPIENT INFORMATION
Recipient's Name:
Class Title (if known):
Agency/Division/Bureau or District/Region/Institution:
People First Employee ID # (if known):
Part II - For Personnel Office(s) Use
Recipient's Agency
Donor's Agency
Date:
/ /
Date:
/ /
Send To:
Send To:
Sick Leave Transfer (SLT) Plan Administrator (SLT)
Sick Leave Transfer (SLT) Plan Administrator
Personnel Office/Human Resources
Personnel Office/Human Resources
Department of
Department of
Telephone:
Telephone:
Fax:
Fax:
Hours Credited:
PPE:
/ /
Hours Charged:
PPE:
/ /
Hours Credited:
PPE:
/ /
Approved
Disapproved
Hours Credited:
PPE:
/ /
SLT Administrator's Signature: _____________________
Approved Per Criteria
Disapproved Per Criteria Print SLT Administrator's Name:
SLT Administrator's Signature: ______________________
To send unused sick leave back to donor,
complete the reverse side of this form.
Print SLT Administrator Name:
DMS-SLDONATE Rev. 12/05 - DJJ Rev. 6/18
ATTACHMENT 2
Part III - Return of Unused Sick Leave Hours
To:
Agency
Sick Leave Transfer Plan Administrator
Address
From:
Agency
Sick Leave Transfer Plan Administrator
Signature
Please credit
hours back to:
Employee Name
People First Employee ID#:
Return to the Bureau of Human Resources, Attendance & Leave, 2737 Centerview Drive, Tallahassee, Florida 32399-3100
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DMS-SLDONATE Rev. 12/05 - DJJ Rev. 6/18
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