Gaithersburg Request For Advancement Of Sick Leave printable pdf download

Gaithersburg Request For Advancement Of Sick Leave

City of Gaithersburg

Request for Advancement of Sick Leave

In exceptional cases, a non-probationary classified employee or unclassified management

employee, or a probationary classified employee or unclassified management employee who has

successfully completed at least six months of his/her probationary period, may be advanced,

with prior approval from his/her Department Head and the City Manager, unearned paid sick

leave for a serious health condition. An employee requesting an advancement of sick leave will

be required to provide medical certification from the employee's or the employee's family

member's treating physician to be eligible. The Department Head and the City Manager shall

determine, on a case-by-case basis, the amount of sick leave that may be advanced and

whether the employee must exhaust all leave (i.e., annual, sick, personal, compensatory, etc.)

prior to the advancement of sick leave, taking into consideration such factors as the employee’s

past performance and history of leave use.

Upon returning to work, the employee shall not be permitted to use accrued sick leave until the

debt to the City has been repaid. In the event an employee is separated from City employment

before the debt to the City is repaid, the remaining portion of unearned paid sick leave shall be

deducted from the employee's unpaid salary, accrued annual leave, compensatory time, or

retirement contributions owed to the employee. The City must give the employee or former

employee written notice of the deduction and an opportunity to respond within three days.

Please provide a brief description of the circumstances necessitating the requested leave:

Attached medical documentation

 Yes

 No (explanation must include why)

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Gaithersburg Request For Advancement Of Sick Leave