Get Sick Leave Bank Program Authorization Form - Montgomerycountymd

The Sick Leave Bank Program Authorization Form allows users to apply for additional sick leave benefits when they are unable to work due to illness or injury. This guide will provide a comprehensive overview of how to complete the form online, ensuring that all necessary information is accurately documented.

Follow the steps to successfully complete the Sick Leave Bank Program Authorization Form.

1. Click ‘Get Form’ button to obtain the Sick Leave Bank Program Authorization Form and open it in your online editor.
2. Begin filling out the form by providing your full name, employee ID, and date of birth. Ensure that all personal details, including your street address and contact information, are accurately entered.
3. Indicate your department or division and regular work hours. Additionally, provide your job title and the name of your supervisor.
4. Specify whether you are a member of the Sick Leave Bank, whether all your paid leave has been exhausted, and the dates of any leave that has been taken. If you are applying for a block of days or intermittent leave, check the appropriate boxes.
5. Respond to the questions regarding your health condition, including whether you have been absent for seven consecutive working days due to the illness or injury, and whether a Family and Medical Leave Act (FMLA) request has been completed.
6. Attach the required medical certification from your healthcare provider, ensuring it includes relevant details such as dates and specifics about the condition.
7. Read the policy governing the Sick Leave Bank and acknowledge your understanding by signing and dating the form.
8. Once you have completed and reviewed all sections of the form, save changes, and choose your preferred method to submit: download, print, or share the completed form.

Complete your Sick Leave Bank Program Authorization Form online today to ensure timely processing of your request.