CHRISTIAN APPALACHIAN PROJECT, INC

 

 

Employee Name: ______________________________________________

 

Program Name: _________________________________________

 

Program Number: _________________

 

Current Sick Leave Balance: ________________________Hours

 

Number of hour(s) Donated: _______________ Hours (must be in whole-hour increments)

 

New Sick Leave Balance Total: ___________________ Hours

 

Employee donated to: ______________________________________________________________________

 

I understand that this donation is strictly voluntary and is not subject to revocation or retrieval.

 

 

__________________________________­­____________        

Employee’s Signature                                        Date                        

 

 

______________________________________________

Supervisor’s Signature                                       Date

 

 

Date Approved _______________________________

 

 

 Date Denied _________________________________

 

If denied, explanation:

 

__________________________________________________________________________________________

 

__________________________________________________________________________________________

 

___________________________________________             

Human Resources Representative                                                

 

_________________________

Date