Sick Leave Donation Application
Complete the Sick Leave Form (PDF)
(AKA "Pink" Sick Leave Form)
The Sick Leave Form is used
- Whenever an employee takes more than three (3) to five (5) consecutive days of sick leave in accordance with Civil Service Rules and their labor agreement
- When an employee has used more than 12 days of unverified sick leave within a year; or
- To verify sick leave when an employee is requesting a medical leave for himself or herself; or
- When an employee is planning to return to work after an illness or injury and when a medical release is required to return.
Individual departments may have policies requiring this form be used at other times as well.
The form is retained by the employee's department to document medical verification of sick leave in the above circumstances. However, a copy may need to be sent to the Human Resources Department for the employees personnel service file if:
- The form is related to a request for or return from any kind of medical leave of absence other than FMLA (FMLA requires a different form); or
- A return to work from a medical leave or a work-related injury; or
- When requested by Human Resources staff.
Last updated Jan 2, 2019