MCVSD51 - MVEA sick leave bank
Welcome to the Sick Leave Bank page. We hope that the information provided here will help you in the process of applying to the Sick Leave Bank.
What to Know
D51/MVEA Application Packet
Currently, Sick Leave Bank application packets are available at the MVEA office and at the MCVSD51 Human Resources office. Please be sure to have all information complete so that processing your application is not delayed. The application packet includes the following forms:
Application Details & Reminders
Please note that the following is a simplified & paraphrased list for your convenience. Refer to actual forms if there is any conflicted understanding.
Licensed Covered Employee (MVEA) Sick Leave Bank Guidelines/Release Form
This form covers the D51/MVEA Agreement Section 10 - Sick Leave Bank. Your signature states that you authorize memers of the MVEA Sick Leave Bank to review your enclosed medical information.
Sick Leave Bank Request Application (1 page, 4 sections)
Section 1 - Check the 2nd box for MVEA Sick Leave Bank
Section 2 - Your information.
*Please be sure to include all information, including your employee ID #.
*Print your address legibly! A copy of the disposition of your application will be mailed to you at this address!
*Be sure that the requested block of leave time dates begin on the first working day after your Personal Leave days run out
and total hours/days equal the block of leave time requested.
Section 3 - Be sure to have your Health Care Provider complete this section when he or she fills out your FMLA packet!
*Dates need to correspond with the information in your FMLA packet!
Section 4 - Board Use Only
FMLA Packet (Certification of Health Care Provider for Employee's Serious Health Condition)
PAGE 1
Section 1 - Your employer and job information. Please be complete.
Section 2 - Your Name
Section 3 - Health Care Provider Information
PAGE 2
Part A - Medical Facts
*Date condition commenced and probable duration.
*Medical Care Facility Admission
*Dates Treated and if treatments expected more than twice per year.
*Medication prescribed?
*Referral to another health care provider?
*Pregnancy(?) and expected due date if cesarean
*Is employee unable to perform job functions due to condition, and what part is employee unable to perform.
*Describe any other relevant medical facts related to condition.
PAGE 3
Part B - Amount of Leave Needed
- Information regarding your medical condition. Review this with your provider and be certain that all information is present!
* Beginning & Ending Dates
*Treatment Plan/Schedule
*Expected episodic flare-ups of the condition.
PAGE 4
FMLA Employee Rights and Responsibilities
What to Know
- If you wish to apply, print out the packet by clicking on the link above. You can submit it either to the MVEA Office or to Michelle Wilcox at the D51 Human Resources Office. You may drop it off in person or use district mail to send it to either location.
- Check the information below for guidance as you fill out the form. If you have questions regarding the completion of your packet, please call the MVEA office, or Michelle Wilcox at the D51 human resources office.
- Sick Leave Bank Board meets on the 2nd Monday of every month during the school calendar barring holidays or scheduling conflicts.
Sick Leave Bank Board will notify you of the Approval/Denial of your claim by US Postal Service to the address you provide. - If your condition is expected to extend through the month for which you are applying, please include dates through the end of that month!
D51/MVEA Application Packet
Currently, Sick Leave Bank application packets are available at the MVEA office and at the MCVSD51 Human Resources office. Please be sure to have all information complete so that processing your application is not delayed. The application packet includes the following forms:
- Information Cover Page explaining the contents and procedures of your application.
- Sick Leave Bank Guidelines/Release Form
- Sick Leave Bank Request Application
- FMLA Packet - 4 pages -- This is the application for leave that is protected by the Family Medical Leave Act. See MCVSD51 FMLA Policy for more information.
Application Details & Reminders
Please note that the following is a simplified & paraphrased list for your convenience. Refer to actual forms if there is any conflicted understanding.
Licensed Covered Employee (MVEA) Sick Leave Bank Guidelines/Release Form
This form covers the D51/MVEA Agreement Section 10 - Sick Leave Bank. Your signature states that you authorize memers of the MVEA Sick Leave Bank to review your enclosed medical information.
Sick Leave Bank Request Application (1 page, 4 sections)
Section 1 - Check the 2nd box for MVEA Sick Leave Bank
Section 2 - Your information.
*Please be sure to include all information, including your employee ID #.
*Print your address legibly! A copy of the disposition of your application will be mailed to you at this address!
*Be sure that the requested block of leave time dates begin on the first working day after your Personal Leave days run out
and total hours/days equal the block of leave time requested.
Section 3 - Be sure to have your Health Care Provider complete this section when he or she fills out your FMLA packet!
*Dates need to correspond with the information in your FMLA packet!
Section 4 - Board Use Only
FMLA Packet (Certification of Health Care Provider for Employee's Serious Health Condition)
PAGE 1
Section 1 - Your employer and job information. Please be complete.
Section 2 - Your Name
Section 3 - Health Care Provider Information
PAGE 2
Part A - Medical Facts
*Date condition commenced and probable duration.
*Medical Care Facility Admission
*Dates Treated and if treatments expected more than twice per year.
*Medication prescribed?
*Referral to another health care provider?
*Pregnancy(?) and expected due date if cesarean
*Is employee unable to perform job functions due to condition, and what part is employee unable to perform.
*Describe any other relevant medical facts related to condition.
PAGE 3
Part B - Amount of Leave Needed
- Information regarding your medical condition. Review this with your provider and be certain that all information is present!
* Beginning & Ending Dates
*Treatment Plan/Schedule
*Expected episodic flare-ups of the condition.
PAGE 4
FMLA Employee Rights and Responsibilities
