Transcription of Application to Receive Sick Leave
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Application to Receive Sick Leave
Employee: Please fill out the top portion of this form, print, sign and give to your Agency Personnel Officer (APO)/Agency Representative. Adoctor's note must accompany your request. If you are unsure of any information, ask your Agency Personnel Officer (APO).Program Type:Are you serving in a title eligible for collective bargaining?Yes NoAre you a full-time employee?Have you worked for the City for at least two years? NoYesEmployee Signature:Date: NoYesEmployee Authorization:APO / Agency Representative Certification: Please fill out the following information according to PMS, sign and keep for your records.**Utilize this information to complete the Case Questionnaire found on the APO Portal.** Note: It is the responsibility of the APO/Agency Representative to submit an employee's correct information and to follow the policies according to each program.
Employee: Please fill out the top portion of this form, print, sign and give to your Agency Personnel Officer (APO)/Agency Representative.A doctor's note must accompany your request. If you are unsure of any information, ask …
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