№ lp_2_1_26938
Administrative employment form used by the Texas Department of Criminal Justice to process employee requests for withdrawal of hours from the sick leave pool due to catastrophic injury or illness affecting the employee or an immediate family member.
Organization: Texas Department of Criminal Justice
Document Type: Administrative form
Form Title: Sick Leave Pool Application for Withdrawal
Jurisdiction: Texas
Country: United States
Subject: Sick leave pool withdrawal due to catastrophic injury or illness
Eligible Applicants: Employees of the Texas Department of Criminal Justice
Related Law: Texas Government Code §§ 552.021, 552.023, 559.004
Required Documentation: Licensed practitioner’s statement describing injury or illness and date of onset or diagnosis
Approval Authority: Warden, Department Head, or Designee; Sick Leave Pool Administrator
Maximum Hours Granted: 240
Distribution: Employee Master Human Resources File; Employee Unit or Department Medical File (Sick Leave Section); Employee copy
Price: 8 / 10 USD
The file will be delivered to the email address provided at checkout within 12 hours.

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