PTO/Sick Leave Donation Form


 

Employee name:                            

I authorize CFD, under the outlined conditions, to transfer the following leave to the recipient’s donated leave bank.

Conditions:

  • Donated hours cannot be more than 50% of my current earned balance.
  • Hours donated on an hour-for-hour basis in four-hour increments.
  • The hours are donated to a recipient who meets the eligibility requirements.

Donation To:          Number of Hours Donated:  

I would like my donation to remain anonymous:


Verification of Eligibility

To be completed by Human Resources

 

Employment Year:                                         

Current PTO/Sick Leave Balance:                  

Current Earned PTO/Sick Leave:                 

Previously Donated Hours:                           

Total Donated PTO/Sick Leave Approved:   

Total PTO/Sick Leave Remaining:                 

 

Transfer made for the following pay date:     

Leave this empty:

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Signature Certificate
Document name: PTO/Sick Leave Donation Form
lock iconUnique Document ID: 56ca3a38bc38fbde2b59b7270fa4bc8bbe185c57
Timestamp Audit
March 10, 2023 2:20 pm PSTPTO/Sick Leave Donation Form Uploaded by Do Not Reply - donotreply@c-f-d.org IP 65.157.96.202
March 10, 2023 3:17 pm PSTStella - stice@c-f-d.org added by Do Not Reply - donotreply@c-f-d.org as a CC'd Recipient Ip: 65.157.96.202
March 10, 2023 3:19 pm PSTStella - stice@c-f-d.org added by Do Not Reply - donotreply@c-f-d.org as a CC'd Recipient Ip: 65.157.96.202
March 10, 2023 3:26 pm PSTStella - stice@c-f-d.org added by Do Not Reply - donotreply@c-f-d.org as a CC'd Recipient Ip: 65.157.96.202
March 10, 2023 3:28 pm PSTStella - stice@c-f-d.org added by Do Not Reply - donotreply@c-f-d.org as a CC'd Recipient Ip: 65.157.96.202
March 10, 2023 3:29 pm PSTStella - stice@c-f-d.org added by Do Not Reply - donotreply@c-f-d.org as a CC'd Recipient Ip: 65.157.96.202
March 10, 2023 3:37 pm PSTStella - stice@c-f-d.org added by Do Not Reply - donotreply@c-f-d.org as a CC'd Recipient Ip: 65.157.96.202