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Forms: Request for Leave

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Sup. Request for Leave

by Cindy Beattie

September 01, 2011

Riverside Community School District

Request for Leave

 

Employee Name:  

Email Address:  

Today's Date:  

Date or Dates for Requested Leave:

Please select the type of leave requested. Provide all information requested.

Additional Information Needed:

Family Illness Leave - 15 days per year. Select family member:

Bereavement - Up to 5 consecutive days per occurrence. Select family member:

Professional Leave - State name of workshop, etc.:

Descriptions of Leave

Sick Leave, Medical or Dental Appointments - 15 days received per year, unused days accumulate up to 120 days

Family Illness Leave - 15 days per year to be deducted from sick leave (parent, spouse, child, step-child)

Personal Leave - 2 days per year which may accumulate up to a maximum of 3. May be taken in full or one-half day segments, two day notice.

Bereavement - Up to 5 consecutive days per occurrence. (spouse, mother, father, son, daughter, step-child, sister, brother, parent-in-law)

Bereavement - Up to 2 consecutive days per occurrence. Any other relative of the employee.

Bereavement - Up to 1 day per occurrence. Superintendent may approve up to one day for any funeral. MUST BE APPROVED BY THE SUPERINTENDENT PRIOR TO LEAVE.

Vacation

Jury and Legal Leave - Fees to be turned over to the district.

Professional Leave - state name of the workshop, etc.

Unpaid - MUST BE APPROVED BY THE SUPERINTENDENT PRIOR TO LEAVE

 

Employee Signature (by entering name, you are signing document):

Name of Sub (if known) AM:

Sub (if different) PM:

Time of day needed for requested leave:

Note: Payment for leaves will be based on the number of leave days left in the individual's account. Please contact Central Office if you have any questions about the amount of leave that you have available. 07/06

 

 
 

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