This form is for California Chuze employees who would like to request COVID-19 Supplemental Paid Sick Leave (SPSL) to cover the time they are unable to work due to a covered COVID-related reason. Your responses on this form will remain confidential but may be made available to your direct manager and/or their managers, and members of the COVID Reporting Team to include Compliance, HR, and Benefits. Answering honestly and accurately will assist us in both determining pay amount and eligibility.
In the event an employee would like to request multiple types of paid leave, this form can also be used to request their accrued Vacation and Sick Leave. The Benefits team will review all requests to confirm employees' accrued leave balances. Requests for leave over an employee's accrued balance will be approved up to the employee's accrued available* balance, with the difference being left as unpaid leave.
*Please note that the Sick Leave "balance" listed in ADP does not represent the amount of Sick Leave available to use. CA employees may use up to 24 hours of sick leave in a calendar year. Employees working in the City of San Diego may use up to 40 hours of sick leave in a calendar year. If you have already taken paid sick leave in 2022, this will affect your "available" balance.
Email email@example.com if you have any questions about this supplemental leave or paid time off.