Join the Sick Leave Bank

Name:

*Employee ID:

*Last 4 Digits of Social Security Number:

School/Location Name & Number:

DEPOSIT AUTHORIZATION OF ONE SICK DAY
By signing this form you verify that all information is correct and accurate and you do hereby voluntarily agree toc ontribute one of your accumulated sick days to the JCTA Sick Leave Bank (SLB). You understand that this form authorizes JCPS payroll to distribute one of your sick days to the JCTA Sick Leave Bank (SLB).

Your enrollment is valid until September 1, 2029.

Signature:

Today's Date:

Submit

*The Jefferson County Public Schools Payroll Department and JCTA are required to verify your name and school, please provide the last four digits of your Social Security Number or your JCPS Employee ID Number.

**JCTA SLB Enrollment is for certified teachers of JCPS