Board Of Aldermen - Agenda - 11/26/2019 - P94

APPENDIX #9C:

UAW-Professional Employees-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 VAVMPrefessional
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 BAM Prefessionat
Erapteyees-of the Nashua Police Department.

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

83