NOTE: THE BELOW DOCUMENT refers to Los Angeles specific laws; modify as needed but this is a great starting place.
Worker Full Name: Worker Email:
Client / Assignment Supervisor Name Supervisor Email Phone # Optional Fax #:
Employee: Please enter the date(s) and hours of any used accrued sick leave for the pay period. To determine your accrued sick leave balance, review your most recent paystub, or visit https://ipay.adp.com. Contact our office if you have questions or concern regarding your balance. Submit this form by clicking Sign & Send below along with your time card, or email it with the corresponding work dates to: YOUR COMPANY CONTACT HERE
*Sick Leave Qualifying Events: Sick Leave is not intended for personal time off, vacation or holiday pay. See Policy below for full details.
Accrual Amount:An employee will earn one (1) hour of paid sick leave for every thirty (30) hours worked on an assignment.
Maximum Balance - Cap:Employees will NOT accrue more than seventy two (72) hours of sick leave at any given time. Therefore, once an employee has accrued seventy two (72) hours of sick leave, he or she will cease accruing sick leave time until he or she, through use of sick leave, has drawn down his or her sick leave balance (bank of sick leave) to less than seventy two (72) hours. Once the sick leave balance (or bank) has fallen below seventy two (72) hours, the employee will resume accruing sick leave at the rate of one (1) hour of paid sick leave for every thirty (30) hours worked. Accrued sick leave shall carry over to the following calendar year, but is subject to a maximum balance - cap of seventy two (72) hours.
Limit on Amount of Paid Sick Leave that Can Be taken Each Year:Los Angeles Employees may not use more than forty eight (48) hours and Santa Monica Employees not more than seventy two (72) hours of sick leave in a year.For purposes of this section, a "year" is determined as follows:
*Sick Leave Qualifying Events: An employee can take accrued sick leave for scheduled work hours for him or herself, or a family member, for diagnosis, care (including preventative care) or treatment of an existing health condition or for specified purposes if he or she are a victim of domestic violence, sexual assault or stalking. Family members include the employee's parent, child, spouse, registered domestic partner, grandparent, grandchild, and sibling. For Los Angeles Employees, family members also include any individuals related by blood or affinity whose close association with the employee is the equivalent of a family relationship. Preventive care includes annual physicals or flu shots. Sick Leave is not intended for personal time off, vacation or holiday pay.
Notice of Sick Leave Use: Employee are permitted to use his or her accrued paid sick leave upon an oral or written request. An employee is NOT required to find a replacement as a condition for using leave. If the need is foreseeable the employee must give reasonable advance notice, but where the need is unforeseeable the employee need only give notice as soon as practicable. Employees should promptly called their recruiter at YOUR COMPANY NAME HERE upon determining the need to use accrued sick leave. This will allow the Company to contact the assignment and notify the supervisor of the absence. Los Angeles Employees may be required to provide reasonable documentation to support any sick leave taken in excess of twenty four (24) hours a year.
Increments of Use: An employee may use accrued sick leave in increments of 2 hours (partial days), but otherwise the determination of how much time is needed is left to the employee and his or her earned sick leave bank balance. An employee will not be permitted sick leave advances. Therefore, if an employee's balance is zero, he or she cannot be paid sick leave hours in advance of accrued sick leave.
Waiting Period: There is no waiting period for an employee to use accrued sick leave.
Payout upon Termination: Accrued sick leave is NOT paid to an employee upon termination or retirement for any reason. If an employee leaves the Company and is rehired within 12 months, an employee can reclaim what, if any, accrued sick leave was left in his or her leave bank at the time of termination.
Documentation of Available Sick Leave: An employee's weekly pay stub will reflect available sick leave.
If you have any questions regarding our Sick Leave Benefit Program, please contact our office for further information.
By clicking Sign & Send below you agree to the terms contained herein, and that terms are binding in your jurisdiction as defined in our Electronic Signature Disclosure & Consent
Document Blockchain ID: cCI3Amjt2K3OgZc3WGQLIgkvvimegDIFKsEOLO0rNNs1wfElMQp8aJbRkmS0n13y, Signed on: , Signor 1 given identity: [email protected], email verified by user, Login with Google Secure OAuth, IP Address: , Via browser: , Running on: , Language: , Timezone: , Resolution: , Destruction Date: , Document last modified prior to signature:
This website has elected to use electronic signatures as the default choice in lieu of paper. Be advised that according to the U.S. Federal E-SIGN Act in addition to various state laws an electronic signature is legally the same as a paper and ink signature. Also be advised in event enforcement is needed, all signatures are held in trust by SwiftSignature.com, as a neutral 3rd party, and may be legally enforced in court of law as per the terms of your respective contract.
Federal law requires certain safeguards to ensure that both consumers and vendors have the capability to receive copies of documents upon signature and are advised of the consequences of agreeing to receive documents electronically. Federal law also requires your consent to use e-mail and electronic versions of said contract and/or agreements, disclosures, and other documents and records, herein referred to as simply "electronic documents" that would otherwise be legally binding only if provided to you on paper as a printed physical document.
Electronic Documents for purpose of this disclosure include any documents signed using the Swift Signature service. All documents once signed cannot be revoked or canceled and will be stored for a minimum period of ten (10) years, and are available to either party at any time through our electronic web portal.
All signors are automatically entitled to a free document storage account within Swift Signature, the cost of which is given to you by the owner of this website. After signature, you may follow the prompts to save your document to your free account, where it will be accessible for a minumum of 10 years. This account is optional and available as a courtesy to you.
Note you do have the right to withdraw your consent to receive and/or use electronic documents, but be advised this does not cancel or revoke any prior documents for which permission existed at that time. The legal validity and enforcement of electronic documents, signatures, and deliveries used prior to revocation of consent will not be affected. To withdraw your consent, please contact the owner of this website.
You have the right to have any document in paper form, should you choose at no charge to you. To request paper documents, please contact the party who referred you to this service.
By clicking "Sign and Send" on any document posting to SwiftCloud servers, you are agreeing to the terms contained herein, and are providing your consent to the use of electronic documents and signatures, as well as e-mail or sms phone message delivery of related electronic documents. You are also acknowledging receipt of this disclosure.
Hardware & Software Requirements
Acknowledgement of your access and consent to electronic records and electronic signature
By clicking "Sign & Send" on any document posting to this service, you agree that
Electronic Signature Disclosure & Consent