Form DOC03-115 "Shared Leave Donation" - Washington

What Is Form DOC03-115?

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

Form Details:

  • Released on March 25, 2021;
  • The latest edition provided by the Washington State Department of Corrections;
  • 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 printable version of Form DOC03-115 by clicking the link below or browse more documents and templates provided by the Washington State Department of Corrections.

ADVERTISEMENT
ADVERTISEMENT

Download Form DOC03-115 "Shared Leave Donation" - Washington

Download PDF

Fill PDF online

Rate (4.5 / 5) 14 votes
SHARED LEAVE DONATION
Donor name
Personnel ID number
Facility/office
I am requesting to donate the following number of hours:
Annual leave:
Sick leave:
Personal holiday:
I am requesting my donation be applied to:
Veterans’ In-State Service Shared Leave Pool
The Uniform Service Shared Leave Pool
Foster Parent Shared Leave Pool
Department employee approved for shared leave
Employee name:
Agency name and location:
This donation will not cause my vacation leave balance to fall below 80 hours or my sick leave
balance to fall below 176 hours. I understand that leave not used by the recipient, and meets the
requirements per RCW 41.04.665, will be returned to my appropriate leave balances and prorated
based on the original donation.
This is a voluntary request on my part and is conditional upon approval by the Secretary/designee
when the donation is to an employee working in another state agency.
I request to remain anonymous
Signature
Date
PAYROLL OFFICE USE ONLY
Date received by payroll:
Anniversary date:
Sub-agency:
Attendance unit:
Salary: $
Hourly wage: $
Vacation leave:
Donable
Not donable
Sick leave:
Donable
Not donable
Personal holiday:
Donable
Not donable
The contents of this document may be eligible for public disclosure. Social Security Numbers are considered confidential information and
will be redacted in the event of such a request. This form is governed by Executive Order 16-01, RCW 42.56, and RCW 40.14.
Distribution: ORIGINAL - Applicable Region Payroll Office (i.e., Southwest, Northwest, or East) via mail or email
DOC
SW Region Shared
Leave,
DOC NW Region Shared
Leave,
DOC East Region Shared
Leave;
Government Agency, if applicable
DOC 03-115 (Rev. 03/25/21)
DOC 830.030
SHARED LEAVE DONATION
Donor name
Personnel ID number
Facility/office
I am requesting to donate the following number of hours:
Annual leave:
Sick leave:
Personal holiday:
I am requesting my donation be applied to:
Veterans’ In-State Service Shared Leave Pool
The Uniform Service Shared Leave Pool
Foster Parent Shared Leave Pool
Department employee approved for shared leave
Employee name:
Agency name and location:
This donation will not cause my vacation leave balance to fall below 80 hours or my sick leave
balance to fall below 176 hours. I understand that leave not used by the recipient, and meets the
requirements per RCW 41.04.665, will be returned to my appropriate leave balances and prorated
based on the original donation.
This is a voluntary request on my part and is conditional upon approval by the Secretary/designee
when the donation is to an employee working in another state agency.
I request to remain anonymous
Signature
Date
PAYROLL OFFICE USE ONLY
Date received by payroll:
Anniversary date:
Sub-agency:
Attendance unit:
Salary: $
Hourly wage: $
Vacation leave:
Donable
Not donable
Sick leave:
Donable
Not donable
Personal holiday:
Donable
Not donable
The contents of this document may be eligible for public disclosure. Social Security Numbers are considered confidential information and
will be redacted in the event of such a request. This form is governed by Executive Order 16-01, RCW 42.56, and RCW 40.14.
Distribution: ORIGINAL - Applicable Region Payroll Office (i.e., Southwest, Northwest, or East) via mail or email
DOC
SW Region Shared
Leave,
DOC NW Region Shared
Leave,
DOC East Region Shared
Leave;
Government Agency, if applicable
DOC 03-115 (Rev. 03/25/21)
DOC 830.030