ST. JAMES R -l SCHOOL DISTRICT REQUEST TO DONATE LEAVE UNDER THE VOLUNTARY LEAVE TRANSFER PROGRAM I request that leave, as indicated below, be transferred to the account of the leave recipient after they have exhausted all eligible leave days for a m edical/fam ily crisis. This recipient is not m y im m ediate supervisor. As of the date indicated below, I have enough of the indicated leave in my account to cover the indicated leave donation. I understand that the am ount of leave I am transferring may not exceed the number of days rem aining in the year for which the recipient is scheduled to work. The am ount of leave I am transferring also is not more than half of the days I will earn this year. I understand that my decision to donate leave is not revocable. I understand that donated leave will be used on a "first donated" basis and if the leave I donate is not used, it will be returned to m y leave account. I have not been directly, or indirectly, intimidated, threatened, coerced, or promised any benefit by the receiving recipient in exchange for the donated leave days.

TO BE COMPLETED BY LEAVE DONOR: Name of Recipient__________________

Name of Donor______________________________________ Social Security Number_

Num ber of Days to be Donated Type of Leave:

Leave Com pensatory (classified only) Vacation (classified only)

Signature of Donor__________________________________

Date_

Approved_______________ Not Approved

Date

Leave Transfer Entered By_____________

Date

Request to Donate Leave Under the Voluntary Leave Transfer ...

Leave Transfer Entered By_____________. Date. Date. Page 1 of 1. Request to Donate Leave Under the Voluntary Leave Transfer Program_OCR.pdf. Request ...

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