Sick Pay Form

Sick Pay Form
Instructions

If you are calling out sick for a scheduled shift fo any reasons, please complete the information below in full and one of our HR Associates may contact you if we have any questions. Some fields and responses are optional.
Employee Name
Employee ID
Phone Number
Employee Email
Reasons for use of accrued Sick Pay (Check all that apply)

I am too ill to work - MigraineI am too ill to work - CoughI am too ill to work - AllergiesI am too ill to work - CoughI am too ill to work - Stomach AcheI was not feeling wellFeverFluMedical Appointment for MyselfOther
Client Name 1
Missed Schedule and Comments
Client Name 2
Missed Schedule and Comments
Client Name 3
Missed Schedule and Comments
Signature

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