Common use of Application for Extended Sick Leave Clause in Contracts

Application for Extended Sick Leave. Appendix D Revised: 8-22-2016 Employee’s Name: Date of Birth: Building: Assignment: First work day lost due to THIS disability: Nature of Medical Disability: Employee's Signature Date of Application VERIFICATION BY PHYSICIAN I have examined the above named employee of the Kalkaska Public Schools and I verify that for medical reasons, he/she is unable to work. Date approved to return to work (if known): Physician's Signature Date ********************************************************************************* For Office Use Only ********************************************************************************* Employee’s Year of Service ESL Scale LTD Eligibility Day Days Approved Date returned to work Approval Master Teacher Incentive Program Appendix E Revised: 8-22-2016

Application for Extended Sick Leave. Appendix D Revised: 812-2210-2016 14 Employee’s Name: Date of Birth: Building: Assignment: First work day lost due to THIS disability: Nature of Medical Disability: Employee's Signature Date of Application VERIFICATION BY PHYSICIAN I have examined the above named employee of the Kalkaska Public Schools and I verify that for medical reasons, he/she is unable to work. Date approved to return to work (if known): Physician's Signature Date ********************************************************************************* For Office Use Only ********************************************************************************* Employee’s Year of Service ESL Scale LTD Eligibility Day Days Approved Date returned to work Approval APPENDIX F: Master Teacher Incentive Program Appendix E Revised: 8-22-2016Program

Application for Extended Sick Leave. Appendix D Revised: 812-2210-2016 14 Employee’s Name: Date of Birth: Building: Assignment: First work day lost due to THIS disability: Nature of Medical Disability: Employee's Signature Date of Application VERIFICATION BY PHYSICIAN I have examined the above named employee of the Kalkaska Public Schools and I verify that for medical reasons, he/she is unable to work. Date approved to return to work (if known): Physician's Signature Date ********************************************************************************* For Office Use Only ********************************************************************************* Employee’s Year of Service ESL Scale LTD Eligibility Day Days Approved Date Xxxx returned to work Approval APPENDIX F: Master Teacher Incentive Program Appendix E Revised: 8-22-2016Program