ࡱ> /1. 0bjbj .`77777KKK8 ,K~!777JJJ77~J~JJJ0׍K:Jj0J+p+J+7J JJ+ : PRIVATE & CONFIDENTIAL The University of Sussex PERSONAL SICKNESS CERTIFICATE FULL NAME Mr/Mrs/Miss/Ms & & & & & & & & & & & & & & & & & & & & & & Teaching Faculty  Research Staff  Admin  Technician  ADDRESS & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & . . DATE OF BIRTH.. SECTION/UNIT/SCHOOL.. PERIOD OF SICKNESS Date of fourth day of sickness.Date of return (please include days when you would not otherwise have been at work, as this helps us in reclaiming the cost of your sickness benefits from the DHSS) DETAILS OF SICKNESS/INJURY I was unfit to attend for work for the following reason (e.g. influenza, rheumatism, injury at work etc).. .. DECLARATION I declare that I have not worked during the period of sickness as stated above and that the information I have given is complete and correct EMPLOYEES SIGNATURE.DATE. NOTE Use this form for any sickness of 4,5,6 or 7 days and submit it as soon as you return to work NOTE TO LINE MANAGER If the individual is going to be away for more than 7 days, he/she should let you know this as soon as possible. PLEASE COMPLETE THIS FORM ON HIS/HER BEHALF FOR THE FIRST 7 DAYS. HE/SHE MUST OBTAIN A DOCTORS CERTIFICATE FOR THE REST OF THE SICKNESS PLEASE SUBMIT THIS FORM TO YOUR LINE MANAGER who will then forward it to the Payroll Office, Ƶ House Line Managers signature Date.      FILENAME \p I:\SECRETAR.IES\Forms\Personal Sickness Certificate.doc .0b2 6 \ ^ " / > Q X l i!"$%'(01>?vwx~ʺhF CJmHnHu hF CJjhF CJUjhF UhF 5\] hF ]hF 5>*\] hF CJ4hF 5>*\hF 5CJ\ hF CJhF hF >*-.0bd " = > l m &dh$d%d&d'dNOPQ#$d%d&d'dNOPQ&$$d%d&d'dNOPQa$m Y Z u v l#$d%d&d'dNOPQ&$$d%d&d'dNOPQa$#$d%d&d'dNOPQ#$d%d&d'dNOPQ  ( 4 5 W X ^^.$`$d%d&d'dNOPQ^``a$#$d%d&d'dNOPQ#$d%d&d'dNOPQ)$dh$d%d&d'dNOPQa$ X ij !#$&')*+,-./ $`^``a$$a$.$`$d%d&d'dNOPQ^``a$/0xyz{|}~ $`^``a$ ,1h. A!"#S$S% ^ 666666666vvvvvvvvv666666>6666666666666666666666666666666666666666666666666hH6666666666666666666666666666666666666666666666666666666666666666662 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~_HmH nHsH tH@`@ NormalCJ_HaJmH sH tH >@>  Heading 1$@& 5>*\D@D  Heading 2$$@&a$ 5>*\@  Heading 3R$$$d%d&d'd@&NOPQa$ 5>*\@  Heading 4R$$$d%d&d'd@&NOPQa$5\DA D Default Paragraph FontViV 0 Table Normal :V 44 la (k ( 0No List 6>6 Title$a$ 5>*\@J@ Subtitle$a$ 5>*CJ\4@4 Header  9r 4 @"4 Footer  9r PK![Content_Types].xmlj0Eжr(΢Iw},-j4 wP-t#bΙ{UTU^hd}㨫)*1P' ^W0)T9<l#$yi};~@(Hu* Dנz/0ǰ $ X3aZ,D0j~3߶b~i>3\`?/[G\!-Rk.sԻ..a濭?PK!֧6 _rels/.relsj0 }Q%v/C/}(h"O = C?hv=Ʌ%[xp{۵_Pѣ<1H0ORBdJE4b$q_6LR7`0̞O,En7Lib/SeеPK!kytheme/theme/themeManager.xml M @}w7c(EbˮCAǠҟ7՛K Y, e.|,H,lxɴIsQ}#Ր ֵ+!,^$j=GW)E+& 8PK!Ptheme/theme/theme1.xmlYOo6w toc'vuر-MniP@I}úama[إ4:lЯGRX^6؊>$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! I_TS 1?E??ZBΪmU/?~xY'y5g&΋/ɋ>GMGeD3Vq%'#q$8K)fw9:ĵ x}rxwr:\TZaG*y8IjbRc|XŻǿI u3KGnD1NIBs RuK>V.EL+M2#'fi ~V vl{u8zH *:(W☕ ~JTe\O*tHGHY}KNP*ݾ˦TѼ9/#A7qZ$*c?qUnwN%Oi4 =3ڗP 1Pm \\9Mؓ2aD];Yt\[x]}Wr|]g- eW )6-rCSj id DЇAΜIqbJ#x꺃 6k#ASh&ʌt(Q%p%m&]caSl=X\P1Mh9MVdDAaVB[݈fJíP|8 քAV^f Hn- "d>znNJ ة>b&2vKyϼD:,AGm\nziÙ.uχYC6OMf3or$5NHT[XF64T,ќM0E)`#5XY`פ;%1U٥m;R>QD DcpU'&LE/pm%]8firS4d 7y\`JnίI R3U~7+׸#m qBiDi*L69mY&iHE=(K&N!V.KeLDĕ{D vEꦚdeNƟe(MN9ߜR6&3(a/DUz<{ˊYȳV)9Z[4^n5!J?Q3eBoCM m<.vpIYfZY_p[=al-Y}Nc͙ŋ4vfavl'SA8|*u{-ߟ0%M07%<ҍPK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 +_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!Ptheme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK]  []_bm X /  Xb8@0(  B S  ?_abe  !!#$&')*0w}   !!#$&')*}333333  !!#$&')*xy}VsF  @xx@UnknownG* Times New Roman5Symbol3. * ArialA BCambria Math"1h/f/f&5 5 #S02HP $PVs2!xxTHE UNIVERSITY OF SUSSEXSchool of Biological Sciences IT ServicesOh+'0$ 8D d p | THE UNIVERSITY OF SUSSEX School of Biological Sciences Normal.dotm IT Services2Microsoft Office Word@@\@ @ 5՜.+,0 hp  Ƶ  THE UNIVERSITY OF SUSSEX Title  !"#$%'()*+,-0Root Entry F 21Table+WordDocument.SummaryInformation(DocumentSummaryInformation8&CompObjy  F'Microsoft Office Word 97-2003 Document MSWordDocWord.Document.89q