Revised 10/16

EMPLOYEE DONATION OF ACCRUALS TO THE AME CANCER POOL

	Name:	 		

	

Date of Donation:	(Please Print or Type)

	Please indicate the number of HOURS you wish to donate next to the Type of Accruals you wish to donate from: 

Vacation	 	 Comp.Time	  	 Personal Time	  	   
*Sick Time	  	

*Sick time can be donated on a 2 for 1 basis except during the year immediately prior to separation form service. For example: If you donate 4 hours of sick time; your timesheet is deducted with 4 sick hours and the pool will be credited with 2 hours of donated time. NOTE: Employees planning on retiring, resigning, or leaving their employment cannot donate sick time for the year immediately prior to separation. 

I understand that once I have authorized a donation of time to the Cancer Pool, said hours cannot be restored.

Employee's Signature

PLEASE FORWARD THE ORIGINAL SIGNATURE PAGE TO HUMAN RESOURCES, NFL 124

Cancer Pool Donation Form