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Form preview Sick leave request form You must provide reasonable advance notification by completing a PSL form for foreseeable sick leave requests. If you separate from employment then are rehired within one year previously accrued/unused paid sick days will be restored. Oral requests are acceptable if foreseeable. Family member is defined to include children parents grandparents grandchildren siblings spouse and registered domestic partner. However you must complete a PSL Request form upon return within the pay period you are requesting the sick leave usage. Contact Personnel Office at 846-4721 ext. 31 with any questions or concerns. APPROVALS Supervisor Signature Payroll Processing. Sick leave will be granted per the Health Workplaces Healthy Families Act of 2014. You will accrue one hour of paid sick leave for every 30 hours worked. Sick leave can be used for your own condition including preventive care or to care for a family member. Will be limited up to 24 hours per school year per individual. Employee Signature Date Please complete and submit PSL form to your immediate supervisor. Paid Sick Leave Request Form Substitute/Employee Name Date Submitted Start date for sub assignment Position called in for Absence Confirmation from Aesop End date of sub assignment Shift hours Total hours I am requesting to use hours for the above shift I was called in for. Sick leave can also be used for the employee s treatment or otherwise to get help as a victim of domestic violence sexual assault or stalking.
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