ࡱ> []Z@  bjbjFF "*,,HTTTTTTTh8H Tdh!(   t!v!v!v!v!v!v!"R%@v!T  v!TT4!"TTt!t!rTTTT  j:"8 <!0!VO%O% hhTTTTO%T , 0P"r   v!v!hh "hh Human Resource Services Confidential Employee Donation Form for Catastrophic Leave  Employee Name: (Please Print Last Name, First Name) Last Four (4) Digits of Social Security Number: School/Department: Title: Work Phone: Home/Cell Phone: Name of Employee You Would Like to Donate Eligible Leave Credits to: Their School/Department: Definition of Leave: (Per Education Code 44043.5 [2] Eligible leave credits means sick leave accrued to the donating employee. A minimum of a day1 initially and then in one [1] hour increments.)Sick Leave Hours: I, a member of the Confidential Unit, hereby elect to donate my eligible leave credits to the designated classified employee, also a member of the Confidential Unit, named above for the purpose of mitigating the employees hardship due to a catastrophic illness, suffered by the employee, the employees spouse, or child.Donors Signature: Date: Time: Date Received (Human Resource Services Only):Received by (Human Resource Services Only):  1 The definition of a day is based on the individual classified employees work day pursuant to their job classification/specification. Submit this form to Human Resource Services in a sealed confidential envelope to Box 770, Attention: Human Resource Services, or fax to 643-9454. Please keep a copy for your own records. cc: Human Resource Services, Personnel File 12/20/06; Rev. 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