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Donor Request Form

Donor Request Form

Please complete this form if you would like to donate your accrued leave to a Government Employee who requires an absence from work due to their own or a family members serious health condition or for maternity leave. Please have their email address, department and employee number available when completing this request form.  
20Questions
  • 1

    Any employee who is eligible to accrue sick leave is eligible to participate either as a donor or as a recipient of the Donated Leave Program and must satisfy each of the following requirements:

    Leave Accrual Requirements
    A leave donor shall have at least 160 hours of accrued sick leave and at least 96 hours of accrued annual leave remaining after the leave donation.

    Minimum Donation
    Time must be donated in hour increments only. 

    Continued Service Requirements
    A leave donor must be an active employee at the time the donated leave hours are utilized by the leave recipient. Leave donations made by separated, retiring (within the next 480 hours) and retired employees are prohibited. 

    Return of Unused Leave
    Leave donations are utilized in the following order:

    1.       Sick Leave only donations first, largest to smallest, then alphabetical.

    2.       Annual Leave donations last, largest to smallest, then alphabetical.

    Unused leave donations will not be deducted from the donor's leave bank. Unused leave donations will expire 12 months from their donation. A donor's leave donation may be deducted at any time within that 12 month period. 

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  • 2
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  • 3
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  • 4
    A copy of this request will be sent to your email for your records. Your donor will need a copy of this request to submit with their Donated Leave Application.
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  • 5
    • Agriculture
    • Education (Department of)
    • Board of Education
    • Career and Technical Education Board
    • Casino Control Commission
    • Collective Bargaining
    • Corrections Bureau
    • Economic Development Authority
    • Economic Research
    • Election System
    • Energy Office
    • Finance
    • Fire Service
    • Government Employees' Retirement System
    • Governor's Office
    • Health
    • Housing Authority
    • Housing Finance Authority
    • Human Services
    • Information Technology
    • Inspector General - V.I.
    • Internal Revenue
    • Juan Luis Hospital
    • Judicial Branch
    • Justice
    • Labor
    • Law Enforcement Planning Commission
    • Legislature
    • Licensing and Consumer Affairs
    • Lieutenant Governor's Office
    • Lottery
    • Magens Bay Authority
    • Management and Budget
    • Motor Vehicles
    • National Guard
    • Nurse Licensure
    • Personnel
    • Planning and Natural Resources
    • Police Department
    • Port Authority
    • Property and Procurement
    • Public Broadcasting System
    • Public Defender - Territorial
    • Public Employees Relations Board
    • Public Finance Authority
    • Public Services Commission
    • Public Works
    • Schneider Regional Medical Center
    • School Construction and Maintenance
    • Sports, Parks & Recreation
    • Taxicab Commission
    • Tourism
    • University of the Virgin Islands
    • Veterans Affairs
    • viNGN
    • VITEMA
    • Waste Management Authority
    • Water and Power Authority
    • West Indian Company
    • Test
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  • 6
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  • 7
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  • 8
    Your leave recipient needs a copy of this request to attach to their donated leave request.
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  • 9
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  • 10
    • Agriculture
    • Education (Department of)
    • Board of Education
    • Career and Technical Education Board
    • Casino Control Commission
    • Collective Bargaining
    • Corrections Bureau
    • Economic Development Authority
    • Economic Research
    • Election System
    • Energy Office
    • Finance
    • Fire Service
    • Government Employees' Retirement System
    • Governor's Office
    • Health
    • Housing Authority
    • Housing Finance Authority
    • Human Services
    • Information Technology
    • Inspector General - V.I.
    • Internal Revenue
    • Juan Luis Hospital
    • Judicial Branch
    • Justice
    • Labor
    • Law Enforcement Planning Commission
    • Legislature
    • Licensing and Consumer Affairs
    • Lieutenant Governor's Office
    • Lottery
    • Magens Bay Authority
    • Management and Budget
    • Motor Vehicles
    • National Guard
    • Nurse Licensure
    • Personnel
    • Planning and Natural Resources
    • Police Department
    • Port Authority
    • Property and Procurement
    • Public Broadcasting System
    • Public Defender - Territorial
    • Public Employees Relations Board
    • Public Finance Authority
    • Public Services Commission
    • Public Works
    • Schneider Regional Medical Center
    • School Construction and Maintenance
    • Sports, Parks & Recreation
    • Taxicab Commission
    • Tourism
    • University of the Virgin Islands
    • Veterans Affairs
    • viNGN
    • VITEMA
    • Waste Management Authority
    • Water and Power Authority
    • West Indian Company
    • Test
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  • 11
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  • 12
    Please provide the number of annual leave hours you have accrued as of your last paycheck.
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  • 13
    Please provide the number of sick leave hours you have accrued as of your last paycheck.
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  • 14
    Please indicate the number of hours you would like to donate. These hours can be transferred anytime within the next 12 months.
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  • 15
    Please indicate the number of hours you would like to donate. These hours can be transferred anytime within the next 12 months.
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  • 16
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  • 17
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  • 18
    Are you retiring or resigning within the next 3 months?
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  • 19
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  • 20
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  • 21
    Request Received
    • Request Received
    • Pending- Donated Leave Application not received.
    • Denied-Donor Form incorrectly filled out and cannot be used.
    • Denied-The donor withdrew their donor submission.
    • Denied- Employee does not have enough remaining annual leave hours.
    • Denied- Employee does not have enough remaining sick leave hours.
    • Denied- Employee has separated from government.
    • Denied-Sick leave is not transferable between central government and semi-autonomous agencies or between semi-autonomous agencies.
    • Pending Evaluation
    • Denied- Donation not required at this time.
    • Closed- Donation will not be utilized.
    • Closed- Remaining leave balance hours will not be utilized.
    • Accepted in part- Part of the donation will be utilized.
    • Approved- Submitted to Finance for leave transfer.
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  • 22
    These hours have been or will be deducted from your leave balance within the next 90 days.
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  • 23
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  • Should be Empty:
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