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Lubbock-Cooper ISD
COMPENSATION AND BENEFITS:
LEAVES AND ABSENCES
EXHIBIT B
LOCAL SICK LEAVE POOL REQUEST
TO: Betsy Taylor, LCISD Chief Financial Officer
FROM: _________________________________ _________________________
Name of Requesting Employee Social Security Number
In the space below, explain your need for a sick leave pool. Include a statement from the attending physician and the date of your anticipated return to work.
I have used all of the eligible leave days provided both by the State and Local District.
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Signature Date
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