Voluntary Shared Leave Donation Form

HAYWOOD COUNTY

VOLUNTARY SHARED LEAVE DONATION FORM

Instructions: Please fill out the information below and submit to the Human Resources Directo via your Department Head.

Donor Information:

Employee Name ______

Employee Department ______

Vacation Leave Balance ______As of Date ______

NUMBER OF VACATION HOURS TO BE DONATED ______

(Minimum: Four Hours)

(You must have a balance of eighty (80) hours after donation)

Employee to Receive Shared Leave

Employee Name ______

Department Name ______

I meet all policy requirements for being a Shared Leave Donor and would like to donate the stated hours of Vacation Leave to the employee listed above.

I understand that once this donated Vacation/Comp/Holiday leave is transferred to an eligible County employee, it will not be returned to me under any circumstances.

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Employee’s Signature and Date

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Department Head Signature and Date

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For Human Resources Department Use

Date Received from Employee ______Effective Date for Transfer of Vacation Leave ______

Recipient’s Department ______

Comments ______

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