Skip to content Home About Careers and Job Postings Employee Groups Aviation Associates Coaches Dining Services, Facilities Management and Other (AFSCME) Faculty (AAUP) Part-Time Instructors (PIO) Police Officers (POA) Power Plant (MSEA) Research Staff Retirees Senior Administrative Officers Staff Compensation System Employees Stagehands (IATSE) Student Employees Temporary Employees Form I-9 Forms Accidents and Injuries Benefit Claims Benefit Enrollment and Changes Business Managers and Hiring Agents Jury Duty and Court Required Service Leaves of Absence Performance Management Probation Retirement Staff Collective Bargaining Staff Compensation System System Access and Reporting Office Management Electronic Workflow Reporting Student Employment Resources Policies Aviation Associates Employee Handbook Policy and Procedures Manual Proposed Personnel Policy Changes Research Staff Senior Administrative Officers Policy Staff Collective Bargaining Agreements Resources and Training Your HR Business Partner Directory Contact Us Sick Leave Designation Name (required) Employee ID (required) Department (required) - Select -Custodial (BCSS)DiningLandscapeMaintenance (FM)Alumni Affairs and DevelopmentAuxiliary enterprisesBusiness & Finance -- GeneralCenter for Disability ServicesCollege of Arts and SciencesCollege of AviationCollege of Business (HCOB)College of EducationCollege of Engineering and Applied SciencesCollege of Fine ArtsCollege of Health & Human ServicesMARCOMMerze Tate CollegeConstruction/Remodel ShopDean of StudentsKalamazoo Autism CenterIntercollegiate AthleticsLibrariesLogistical ServicesMulticultural AffairsOffice for SustainabilityOffice of Information TechnologyOffice of the PresidentPolice and parkingPower PlantProvostResearch and Sponsored ProgramsResidence Life/Student AffairsSindecuse Health CenterStudent (non-employee)Transportation (Garage)51福利社x Supervisor (required) Are you currently on a Workers鈥 Compensation Leave? (required) Yes No Are you requesting to use accumulated sick leave to supplement your Workers鈥 Compensation Leave Benefits as stated in Article 9.2.2 of the 2021-2025 51福利社/AFSCME Collective Bargaining Agreement? (required) Yes No How many sick leave hours per pay period are you requesting to use to supplement your Workers鈥 Compensation Leave Benefits? (required) Upon exhaustion of your sick leave bank, do you request to use annual leave to supplement your Workers鈥 Compensation Leave Benefits? (required) Yes No Sick leave will not be deducted from your sick leave bank until the next full pay period after submission of this designation form. As stated in the 51福利社 Employee Safety Policy, Policy & Procedures Manual Section 12: 鈥淎ny employee receiving weekly benefits may use any remaining sick leave in amounts supplementary to weekly workers鈥 compensation benefit checks, not to exceed 100 percent of regular wages.鈥 Once sick leave is exhausted, and if annual leave is elected, your annual leave will be utilized until you return from Workers鈥 Compensation Leave, or your annual leave balance is exhausted.Your decision is non-revocable and will remain in place until you exhaust your paid leave banks, or return to work. You continue to remain responsible for any insurance premiums (i.e. health, life, LTD) being charged to you while on Workers鈥 Compensation Leave. Failure to fully pay an applicable insurance premium may result in loss of continued coverage.You are responsible for any tax consequences that may result from your decision. Verification (required) By clicking this box I verify that I am the employee filling out this form and the information submitted is correct. Submit Leave this field blank
