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[]
["Employee Sick Leave Bank Request Form"]
["FOR EMPLOYEES NOT COVERED BY A COLLECTIVE BARGAINING AGREEMENT WITH THE EXCEPTION OF SHARE AND NAGE EMPLOYEES \n"]
["Nature of Illness or Injury:\nI am applying for time to be granted to me from the Sick Leave Bank and and acknowledge that I have already provided the medical certification as well as the request for leave of absence form, as required.                                                                                                                                                                                                                                                1. Additional documentation and/or medical consultation may be requested by the Sick Leave Bank Committee at any time during my sick leave. My Department Head/Supervisor will be consulted for a review of my past attendance record.\n2. I may not draw on the Sick Leave Bank while also receiving income from Worker's Compensation and/or an employer sponsored disability insurance plan.\n3. All accrued vacation, personal, sick and holiday compensatory time must be used and I must be absent without pay for five days or a pro-rata mount for a regular part-time employee before eligible to draw time.\n4. All vacation and sick time which is accrued for any month during which I am using time from the Sick Leave Bank will be reassigned to the Sick Leave Bank.\n5. The decision of the Committee is binding and is not subject to any campus or grievance appeal procedure.\n"]
[]
[]
["I acknowledge that I have read and agree to all of the terms above."]
[]
[null,null,null,"ALL FIELDS ARE REQUIRED"]
["Date Of Request:"]
["                                                                       ",null,null,null,null,"MM/DD/YYYY"]
["ID and Name of Employee Requesting:"]
["                                                                                        ",null,null,null,null,"              ID                                       ",null,null,null,"          Last name, First name"]
["Department:"]
[]
["Job Title:"]
["                                                                                                                                                                                ",null,null,null,null,null,null,null,null,null," E-mail Address"]
["Home Phone:"]
[null,null,null,null,null,"# # #-# # #-# # # #"]
["Name of Supervisor:"]
[]
["Briefly describe the nature of illness/Injury:"]
[]
[]
["Requested Sick Leave :",null,null,null,null,"Total Hours:"]
[null,null,null,"To"]
[]
[]
["I agree my electronic signature is the equivalent of my manual/handwritten signature on this request form."]
[null,null,null,null,null,null,null,null,null,"                          ","   Employee  Signature"]
["Please email this completed form to:  Benefits.UMMS@Umassmed.edu \n\n",null,null,null,null,null,null,null,"Benefits.UMMS@Umassmed.edu"]
["Benefits will review this information for compliance and mail you a disposition letter of approval or denial as soon as possible"]

{"sheet":"AppDen","index":1,"n_rows":2,"n_cols":1,"rows_kept":2,"cut":false,"hidden":true,"merged":[]}
["Approved"]
["Denied"]

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["INFORMATION FOR NEW EXTENSION FORM"]
[]
["Category","Extension Details"]
[]
["Collaborator - Off Campus","Can be extended in 1 year increments"]
["Collaborator - On Campus","Can be extended in 1 year increments"]
["Contractor ","Can be extended in 6 month increments"]
["Observer","Can be extended in 3 months increments, can be intermittent"]
["Paid Graduate Intern","May be allowed but no greater than their original engagement period. "]
["Paid High School Intern","May be allowed but no greater than their original engagement period. "]
["Paid IT Intern","May be allowed but no greater than their original engagement period. "]
["Paid Psychologist Intern","May be allowed but no greater than their original engagement period. "]
["Paid Undergraduate  Intern","May be allowed but no greater than their original engagement period. "]
["Per Diem","Can be extended in 1 year increments"]
["Post Retiree","Manager must complete a post retirement request form FIRST and return to HR Compensation PRIOR to extending employment"]
["Temprite","Can be extended in 1 year increments - by Human Resources only"]
["Unpaid Intern","Can be extended for up to an additional 6 months with new app"]
["Unpaid Research Trainee","Can be extended for up to an additional 6 months with new applicable documentation; if no documentation provided, no extension will be granted; if post graduate adult, must have approved learning curriculum or no extension will be granted"]
["Unpaid WPI Intern","Can be extended for up to an additional 6 months with new applicable documentation; if no documentation provided, no extension will be granted; if post graduate adult, must have approved learning curriculum or no extension will be granted"]
["Volunteer","Can be extended on a case by case basis to a maximum of 3 months"]
["System Access Memorial (not to include Myers and Howard Hughes)\n\n","Can be extended in 1 year increments"]