REMOVE FROM SICK LEAVE LIST

REMOVE FROM SICK LEAVE LIST
Members Name
,am removing my name from the sick list as of
Date

MonthDayYear
Date
and making myself eligible to take a dispatch.
Member Signature:
Date:
IBEW Card Number
Signature:
(Union Rep Signature)
Date

MonthDayYear
Please return this form to the Marysville or Wenatchee office. Or you can email it to dispatch@ibew191.com.
Should be Empty: