If you are human, leave this field blank.Sick Pay FormInstructionsIf you are calling out sick for a scheduled shift for any reason, please complete the information below in full and one of our HR Associates may contact you if we have any questions. Some fields and responses are optional. Employee First and Last Name *Please list your full nameEmployee Number *What is your employee number? (can be found on paychecks) If you don't know, put UNKMobile Phone *Mobile phone or best number to reach youEmail *(If you do not have an email address, just put none@none.com)Primary reasons for use of accrued Sick Pay *(Please check all that apply. Work-related injuries must be called into HR immediately.)Absence is related to COVID-19Medical appointment for myselfI am too ill to work - Sore ThroatI am too ill to work - CoughI am too ill to work - Stomach AcheI am too ill to work - AllergiesI am too ill to work - MigraineI am too ill to work - InjuryOther (must include comments in each family field below)-----------------------------File UploadPlease upload any documents related to test results or vaccine proof here, if required, or you can email to HR@IslandSocialServices.org -----------------------------Family #1 *Name of the child/adult with whom I was scheduled to workMissed Schedule and Comments #1 *MUST list dates and hours scheduled and reason care was cancelled (eg. Monday 1/2/2023 from 5pm-8pm=3 hours. I was too ill to work.) You can put multiple dates/times if that applies.-----------------------------Family #2Name of the child/adult with whom I was scheduled to workMissed Schedule and Comments #2See Comments #1 section above for directions-----------------------------InstructionsPlease login to Paylocity, our payroll system, to view your current sick pay balance. COVID Supplemental Sick pay expired 12/31/2022 in the state of California, with some exceptions for families receiving services in LA County. If you have any questions, contact Rosy Lopez, HR Manager, at (805) 384-0983 x862 or Rosy@IslandSocialServices.org Captcha *For security verification, please enter any random two digit number. For example: 89Submit