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University of Houston System Sick Leave Pool Contribution/Withdrawal Request
 

Summary: 
University of Houston System
Sick Leave Pool Contribution/Withdrawal Request




Employee Information:
Name: _________________________________________________ Empl ID: _______________________________
Home Address: ___________________________________________ State _______________ Zip _______________
Department: ____________________________________________ Campus: _______________________________
Supervisor Name ______________________________________________ Telephone # _______________________
Sick Leave Pool Contribution
Number of hours you wish to contribute: ____________(Contributions must be made in increments of 8 hours)
Are your retiring or terminating employment? _______ Yes ______ No
Participation in the Sick Leave Pool is voluntary and the contributions are irrevocable. The number of hours
contributed cannot exceed your accrued sick leave balance. If your exhaust all your accrued sick leave hours due to
noncatastrophic illness you may request a withdrawal from the Sick Leave Pool in the amount of hours that you
may have donated in the current fiscal year. Hours contributed to the Sick Leave Pool due to termination or
retirement cannot be refunded should you return to state employment.

  

Source: Azevedo, Ricardo - Department of Biology and Biochemistry, University of Houston

 

Collections: Biology and Medicine; Environmental Sciences and Ecology