Board Of Aldermen - Agenda - 1/2/2020 - P97

APPENDIX #8C:

UAW-Professiona-Empleyees-UFPO Local 645 Professional Employees of the Nashua Police
Department

SICK BANK TRANSFER FORM

Directions: Eligible members will complete the form and submit it to the JAW Prefessional
Employees-UFPO of the Nashua Police Department Sick Bank Committee Chairman or other
member of the Committee in his/her absence. The Chairman or designee will be responsible
for taking the necessary actions to have the transfer take place and to monitor said transfer
into the Sick Bank.

Date:

To: City of Nashua, Payroll Department

| would like to participate in the Sick Leave Bank of the UFPO UAMHPrefessienat
Empleyees-of the Nashua Police Department.

| wish to donate the following number of sick days to the
Program:

83