Open Enrollment - Sick Bank Form

Local 641

TO:                 AFSCME Local 641 Members

FROM:           Douglas Brites, President

DATE:            September 9, 2021

RE:                 Open Enrollment - Sick Leave Bank Donation Form *

As an AFSCME Local 641 member, in good standing, I wish to join and donate one (1) day to the Sick Leave Bank:

 NAME (Please print legibly):                                                                                                         

 SIGNATURE:                                                                                                                                   

 DEPARTMENT:                                                                                                                                

 SCHOOL:                                                                                                                                         

In order to participate in the Sick Leave Bank for this year, this application must be submitted to Local 641 Recording Secretary, Gina Brites (NHBS), no later than Friday, October 29, 2021. If you are already a sick bank member, you do not need to fill out another form!

(If you are already a sick bank member, you do not need to fill out another form! You will be contacted to fill out/sign another form when the sick bank needs replenishment; you can opt out at that time.)

  *Donating to the Sick Leave Bank does not affect your Sick Leave Incentive.