Leave Application_html (2) Version 25.0

Application for Professional Leave

Employee Information Emp NoEmailSelectionNameSelection

Name

Email

Location

Bookkeeper

Employee #

Must obtain number from your school bookkeeper.

CAREER TECH TEACHER

Selection

Leave Dates and Type

Dates Requested

Selection

From

To

Leave Requested

(Attach documentation or agenda)

Source of Funds

Please give details about your agenda.

Multiline Text Input 64Multiline Text Input 93Selection

(if using compensatory time, balance sheet must be atached)

Multiline Text Input 66

Please offer additional details.

Please offer additional details

Multiline Text Input 76

(Attach copy of Employee Accident Report)

Please offer additional details

Multiline Text Input 72

(Attach copy of military orders)

Please offer additional details

Multiline Text Input 68

Additional details (NOT REQUIRED)

Multiline Text Input 76

(Attach copy of subpoena or official court document)

Please offer additional details

Multiline Text Input 70

(Eligible Employees may only use paid sick leave for absenses caused by the following:)

Please attach any supporting documentation.

Please offer additional details

Multiline Text Input 74

Personal Illness
Incapacitating personal injury
Attendance upon an ill member of the employee's immediate family. Defined as a spouse, parent, child, sibling or any person with a close personal tie.
Death of a family member, including a spouse, parent, child, sibling, mother or father-in-law, son or daughter-in-law, brother or sister-in-law, nephew or niece, grandparent, grandchild, aunt or uncle.
Death or care of an individual with whom unusually strong personal ties exist because of a relationship other than those listed above.

HALF Day PM

HALF Day AM

Site Supervisor Approval

Supervisor Name

Comments

Multiline Text Input 96

Text Input 47

Approved

Disapproved

Comments

Approved - Career Tech Director, Dr. Chris Kennedy

Superintendent Confirmation

Superintendent Name

Text Input 55

Disapproved

Confirmed

Comments

Superintendents Comments

A copy of this form will be sent to the Superintendent after it has been approved by your Site Supervisor. A copy will be sent to you after the Superintendent has approved it. NOTICE TO EMPLOYEES: This form will be used to reduce the leave type in the employee's payroll leave balance.
HCBOE: Upated 11/2014

Sharing the Vision; Shaping the Future

ATTENTION
Use the PRINT button in the top right corner of the screen to print this page BEFORE you click SUBMIT.

This field will automatically populate based on the LOCATION selected.

STAGE

Stage Field

For CO use ONLY

Text Input 120

ROLE

Role FieldClick here for Frontline

Houston County Board of Education