Form PERS-18 "Leave Donation Request" - Alabama

What Is Form PERS-18?

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

Form Details:

  • Released on January 1, 2008;
  • The latest edition provided by the Alabama Judicial System;
  • 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 Form PERS-18 by clicking the link below or browse more documents and templates provided by the Alabama Judicial System.

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Download Form PERS-18 "Leave Donation Request" - Alabama

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STATE OF ALABAMA
DATE:
UNIFIED JUDICIAL SYSTEM
LEAVE DONATION REQUEST
PERS-18
REV.1/08
Receiving Employee Information
Donating Employee Information
1. Employee Name
2. Class Title
3. Job Code/
Pay Grade
/
/
4. County/Office
/
/
6. Donated Leave Dates From:_____________________ To:________________________
Check type of leave donated:
Sick # of hours ____
Annual # of hours ____
Compensatory # of hours ____
Total # Donated Hours:________
7. Certification of Receiving Employee:
Explanation of Catastrophic Illness/Injury:_______________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
This request is due to the above referenced catastrophic illness/injury or pregnancy. I certify that donated leave will be
used during the dates listed above in order to continue my compensation because my leave will be exhausted.
Recipient Signature: ______________________________________________
Date: _________________
8. Certification of Recipient’s Appointing Authority:
I certify that this request meets the requirements for transfer of sick, annual, and/ or compensatory leave. I authorize the
addition of the total hours shown in section 6 to the sick leave account of this employee.
Signature: ______________________________________________________
Date: _________________
9. Certification of Donating Employee:
I certify that I am voluntarily requesting permission to donate sick, annual, and/or compensatory leave hours as listed
above. I understand that my leave balance will be reduced by the number of hours listed, and this leave cannot be returned
to me, even if it is not used.
Donor Signature: _________________________________________________
Date: _________________
10. Certification of Donor’s Appointing Authority:
I certify that the hours listed above are available for donation, that this request meets the requirements for sick, annual,
and/or compensatory leave transfer, and that I approve the transfer.
Signature: _______________________________________________________
Date: _________________
11. Approved/Disapproved
ADC Signature: _____________________________________________
Date: ________________
STATE OF ALABAMA
DATE:
UNIFIED JUDICIAL SYSTEM
LEAVE DONATION REQUEST
PERS-18
REV.1/08
Receiving Employee Information
Donating Employee Information
1. Employee Name
2. Class Title
3. Job Code/
Pay Grade
/
/
4. County/Office
/
/
6. Donated Leave Dates From:_____________________ To:________________________
Check type of leave donated:
Sick # of hours ____
Annual # of hours ____
Compensatory # of hours ____
Total # Donated Hours:________
7. Certification of Receiving Employee:
Explanation of Catastrophic Illness/Injury:_______________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
This request is due to the above referenced catastrophic illness/injury or pregnancy. I certify that donated leave will be
used during the dates listed above in order to continue my compensation because my leave will be exhausted.
Recipient Signature: ______________________________________________
Date: _________________
8. Certification of Recipient’s Appointing Authority:
I certify that this request meets the requirements for transfer of sick, annual, and/ or compensatory leave. I authorize the
addition of the total hours shown in section 6 to the sick leave account of this employee.
Signature: ______________________________________________________
Date: _________________
9. Certification of Donating Employee:
I certify that I am voluntarily requesting permission to donate sick, annual, and/or compensatory leave hours as listed
above. I understand that my leave balance will be reduced by the number of hours listed, and this leave cannot be returned
to me, even if it is not used.
Donor Signature: _________________________________________________
Date: _________________
10. Certification of Donor’s Appointing Authority:
I certify that the hours listed above are available for donation, that this request meets the requirements for sick, annual,
and/or compensatory leave transfer, and that I approve the transfer.
Signature: _______________________________________________________
Date: _________________
11. Approved/Disapproved
ADC Signature: _____________________________________________
Date: ________________
LEAVE DONATION REQUEST
1. General: Unified Judicial System employees may transfer sick, annual, and/or compensatory leave hours to
fellow judicial, executive, and legislative branch employees under certain circumstances.
a) The receiving employee must have exhausted all sick, annual, and compensatory leave.
b)
The illness or injury must be “catastrophic”. “Catastrophic” conditions are those that are life
threatening, or from which there is no reasonable expectation of recovery, or where the employee is
unable to return to work for a year or more. Examples of catastrophic conditions are a brain tumor,
rejection of a kidney transplant, and a mother caring for a terminally ill child.
Other medical
conditions that are serious but do not meet the above definition may also qualify for donated leave.
Examples are chemotherapy and pregnancy (only for the period of disability as certified by attending
physician).
Employees requesting donated leave must include a US Dept. of Labor form WH-380,
Certification of Health Care Provider) completed by the attending physician along with the completed
PERS 18, “Leave Donation Request”.
c) Employees whose immediate family members (spouse, child, siblings, grandparents and grandchildren)
have suffered a catastrophic illness or injury, may be eligible to receive donated leave.
d) Leave Donation Request forms should not be submitted for more than one month in the future.
e) Employees who are leaving state service may not donate prior to their separation date.
2. Request Procedure: Request must be submitted on a PERS 18, “Leave Donation Request”.
a) The request should originate with the employee who will be the beneficiary of the donation, and must have
the approval of that employee’s appointing authority (sections 7 and 8).
b) The donating employee and his/her appointing authority complete sections 9 and 10 of the form.
c) Sections 1 through 5 are completed by the recipient’s appointing authority.
d) The PERS 18 must be approved by the ADC prior to the leave being used (no retroactive donations).
f) Donations involving employees in another branch of government will require the use of their appropriate
forms, in addition to the UJS PERS18.
3. Annotating HRDesktop Leave Records:
a) Recipient – Hours received will be posted to recipients sick leave balance by a representative of AOC
Human Resources Division on the HR Desktop automated leave system, in the appropriate pay period.
b) Donor – Hours donated will be posted to the donor’s leave balance by a representative of AOC Human
Resources Division on the HR Desktop automated leave system (depending on the type of leave donated),
in the appropriate pay period.
c). Copies of the PERS 18 form, “Leave Donation Request” should be maintained by the appointing authority
for both the recipient and donor. Record copies will also be maintained by the AOC Human Resources
Division.
4. Use of Donated Leave: Leave donated becomes the property of the recipient, and cannot be returned to the
donor, even if it is not used. Employees continue to earn both sick and annual leave while donated leave is
used as long as they are in pay status for 80% of hours in each pay period.
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