MDEA Catastrophic Sick Leave Form

Mt. Diablo Unified School District

MDEA Catastrophic Sick Leave Bank

The Catastrophic Sick Leave Bank (CSLB) was designed by MDEA to provide income protection to participants in the event of a catastrophic illness.

To be eligible for participation, an individual must have attained permanent status in their employment with the Mt. Diablo Unified School District (MDUSD) and be an active employee of the district.

To join the CSLB, an eligible member must contribute one sick day. Eligible members may join the CSLB at any time, but members who join after September 30th must complete a 30-day waiting period before they may withdraw from the bank.

Members who join the bank before the August pay warrant need not have any remaining accumulated sick days - the required contribution of one (1) sick day will be deducted when the annual sick leave days are credited with the August pay warrant.

Members who join the bank after the August pay warrant must have at least one (1) sick day in their sick leave balance in order to make the required contribution of one (1) sick day.

In the event of a catastrophic illness, a CSLB participant may apply to withdraw from the bank, up to 75 days over their lifetime of employment. These days can then be used to continue income just as sick days in a sick leave balance can be used. Only participants will be permitted to withdraw days from the bank.

Further information about the CSLB is available in the Collective Bargaining Agreement (MDEA Contract) in Article 19, Section 24.

By signing below, a MDEA member is requesting to become a participant in the bank. If the member meets the requirements for participation, one (1) sick day will be deducted from their MDUSD sick leave balance and they will be added to the roster of participants.

I understand that in order to be eligible for the MDEA Catastrophic Leave Bank, I must be in a position that is represented by MDEA.*

Yes, I am in a MDEA represented position.I am not in a MDEA represented position.

Do you have permanent, probationary status or temporary status?*

Permanent StatusProbationary StatusTemporary Status

STOP!!!

You are not eligible. Please do not submit this form.

Employee Name*

Employee Identification Number*

Employee Email Address*

example@example.com

Site*

Job Title*

I understand the terms of eligibility for the Catastrophic Sick Leave Bank (CSLB) and I am requesting to join the Bank. I agree to contribute one (1) sick leave day to the CSLB.

Signature*

Date*

Date