Florence-Darlington Technical College

Office of Internal Relations

PO Box 100548

Florence, SC 29501-0548

843.661.8320

LEAVE TRANSFER PROGRAM DONATION REQUEST FORM

Employee Completes This Section

 

 

 

Employee Name:  Last, First, Middle

 

Social Security Number

Position:______________________________

Dept:______________________________

Donation Type:

Sick

Personal

No. Days_______

No. Hours__________

 I fully understand that any donations will not be refunded to me.

 

 

 

Employee Signature

  

Date

 

Personnel Completes This Section

Class Code:________

Slot:__________

Position No.:_____________

Leave Type

Prior Balance

Balance After Donation

Sick

 

  

 

Personal

 

  

 

Employee Hourly Rate:

$

    

No. Hours Donated:

 

    

No. Days Donated:

$

    

 

 

 

Employee Signature

  

Date

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