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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:

Yes

No

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:

Your legal name

Your email address

Please Confirm full name and signature.

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Timestamp

Audit

March 10, 2023 2:20 pm PDT

PTO/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 PDT

Stella - 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 PDT

Stella - 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 PDT

Stella - 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 PDT

Stella - 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 PDT

Stella - 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 PDT

Stella - 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