REASON FOR ABSENCE. PERSONAL SCHOOL BUSINESS □ Illness – Personal □ Leave of Absence □ Conference, Seminar, Workshop
REASON FOR ABSENCE. All unit members are required to indicate which of the above circumstance is the reason for the absence in order for the absence to qualify for personal necessity leave.
REASON FOR ABSENCE. PERSONAL SCHOOL BUSINESS □ Illness – Personal □ Leave of Absence □ Conference, Seminar, Workshop □ Illness – Family □ Military Duty □ Requested Specific Task □ Bereavement “Immediate Family” □ On-The-Job Injury □ Other □ Medical Appointment □ Dental Appointment □ Compensatory Time Off □ Vacation (Prior Approval) □ Personal Necessity □ Personal Business □ Other (Explain) □ Jury Duty Explain: Substitute was: Employee Signature Date □ Sick Leave □ Personal Leave □ Comp To be checked by approving personnel : Approved Administrator’s Signature Date APPENDIX “D” GROUP INSURANCE PLANS Appendix D Group Insurance Plan The following are the Districts maximum contribution for full-time unit members. The maximum monthly insurance premium contribution for unit members is $919.25. The maximum Contribution per school year is $11,031.00 for medical benefits including health, prescription, dental and vision insurance coverage (pro-rated by relationship to FTE). Monthly Max annual contribution Health (including prescription), Dental and Vision Insurance $ 919.25 $ 11,031.00 Effective July 1, 2013 Board Approved May 8, 2013 APPENDIX “E” TRINITY ALPS UNIFIED SCHOOL DISTRICT RETIREE INSURANCE BENEFITS Appendix E District Retiree Insurance Benefits Consistent with the rules of the insurance provider, the District shall pay the health only coverage for employees retiring under PERS at age 55 or older. Such coverage to extend to age 65 or until the employee is covered under Medicare, whichever occurs first. Such coverage shall be the medical plan in effect for the regular employee. The retiree health benefit will be based on the employees work hours for the previous 3 years. Trinity Alps Unified School District 88 % of District premium contribution Years of District Service for actively employed unit members at time of retirement 10 Years 50% $404.47 15 Years 75% $606.71 16 Years 80% $647.15 17 Years 85% $687.60 18 Years 90% $728.05 19 Years 95% $768.49 20 Years 100% $808.94 Effective July 1, 2013 Board Approved May 8, 2013 APPENDIX “F” EVALUATION FORM Trinity Alps Unified School District Classified Personnel Evaluation Evaluatee Date Exceeds Standards ES Improvement Needed IN Satisfactory S Unsatisfactory U
REASON FOR ABSENCE. PERSONAL SCHOOL BUSINESS □ Illness – Personal □ Leave of Absence □ Conference, Seminar, Workshop □ Illness – Family □ Military Duty □ Requested Specific Task
