Bargaining Leave Pool
"Opt-in" Form
Name
First Name
Last Name
Department Info
Dept Name
Supervisor
Work E-mail
example@sphealth.org
Phone Number
-
Area Code
Phone Number
By Signing and submitting this form I agree to "OPT-IN" to the BLP to donate 1 hour of PL annually in January until I terminate employment or request to "OPT-OUT".
Signature
Continue
Continue
Should be Empty: