APPENDIX #C:
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 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 of the Nashua Police
Department.
| wish to donate the following number of sick days to the
Program:
(Printed Name)
{Signature}
SICK BANK COMMITTEE
(Printed Name}
{Signature}
Cc: NPD, Sick Bank Committee
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