Voluntary Sick Leave Donation for Union Business Pool
*All request will be deducted the following pay period.
(First and Last)
Please provide a current telephone number you may be contacted
Please provide a current e-mail that may be used to contact you
*Hourly increments - minimum donation one (1) hour and a maximum five (5) hours (per calendar year)
Sign below
*Note: By signature and submission of this form, you are voluntarily authorizing the City of Orlando to deduct your unused sick leave hours listed above for the purpose of Union business, as outlines in Article 39 of the collective bargaining contract between the IAFF Local 1365 and the City of Orlando.
Union President / Business Agent Signature: Felix A Benitez
**Below for Payroll Use and Tracking
Total Hours Donated Value:_______________
Value is equal to number of hours donated above divided by 2
Total Donation Monetary Value:___________________
Value is equal to tal hourly rate value divided by 2 Example: 2 hours donated Hourly Rate: $20.00Total Hourly Rate: $40.00Total Donation Value: $20.00