Common use of EMPLOYEE RATING SUPERVISOR Clause in Contracts

EMPLOYEE RATING SUPERVISOR. I have reviewed this report and have had the opportunity to discuss it with my rating supervisor. My signature does not necessarily mean that I agree with the report. I understand that I may respond in writing to this evaluation within 20 working days. The response will be attached to the evaluation and placed in my personnel file. Signature Print Name Signature Date Date Principal/Director’s Signature of Review Appendix C Plumas Lake Elementary School District Leave of Absence CLASSIFIED EMPLOYEES Name (Last, First) Type of Leave: Sick Leave Personal Necessity: Under all circumstances, an employee shall verify in writing that sick leave for personal necessity was not used for vacation, recreation, seeking or engaging in other employment, to extend a holiday or weekend, or for concerted activities against the District. (Initial) Bereavement Relationship: Personal Deduction (full daily deduction) Union Business (specify): School Business (specify): Vacation Workers Comp Comp Time Other (specify): Site: Physician’s Certification: Normally required for absences of more than 5 days. May be required for any absence if requested by Administrator. FROM DATE TO DATE / / / / I CERTIFY THAT THE INFORMATION STATED ON THIS FORM IS TRUE. EMPLOYEE SIGNATURE DATE PRINCIPAL APPROVAL DATE DEPARTMENT APPROVAL DATE # of Days Hrs/Day Total Hours Office Use Only Substitute Name: Personal Illness and Personal Necessity absences reported on this form are charged against the employee’s sick leave bank.

EMPLOYEE RATING SUPERVISOR. I have reviewed this report and have had the opportunity to discuss it with my rating supervisor. My signature does not necessarily mean that I agree with the report. I understand that I may respond in writing to this evaluation within 20 working days. The response will be attached to the evaluation and placed in my personnel file. Signature Print Name Signature Date Date Principal/Director’s Signature of Review Appendix C Plumas Lake Elementary School District Leave of Absence CLASSIFIED EMPLOYEES Name (Last, First) Type of Leave: ☐ Sick Leave ☐ Personal Necessity: Under all circumstances, an employee shall verify in writing that sick leave for personal necessity was not used for vacation, recreation, seeking or engaging in other employment, to extend a holiday or weekend, or for concerted activities against the District. (Initial) ☐ Bereavement Relationship: ☐ Personal Deduction (full daily deduction) ☐ Union Business (specify): ☐ School Business (specify): ☐ Vacation ☐ Workers Comp ☐ Comp Time ☐ Other (specify): Site: Physician’s Certification: Normally required for absences of more than 5 days. May be required for any absence if requested by Administrator. FROM DATE TO DATE / / / / # of Days Hrs/Day Total Hours I CERTIFY THAT THE INFORMATION STATED ON THIS FORM IS TRUE. Office Use Only Substitute Name: EMPLOYEE SIGNATURE DATE PRINCIPAL APPROVAL DATE DEPARTMENT APPROVAL DATE # of Days Hrs/Day Total Hours Office Use Only Substitute Name: Personal Illness and Personal Necessity absences reported on this form are charged against the employee’s sick leave bank.

EMPLOYEE RATING SUPERVISOR. I have reviewed this report and have had the opportunity to discuss it with my rating supervisor. My signature does not necessarily mean that I agree with the report. I understand that I may respond in writing to this evaluation within 20 working days. The response will be attached to the evaluation and placed in my personnel file. Signature Print Name Signature Date Date Principal/Director’s Signature of Review Appendix C Plumas Lake Elementary School District Leave of Absence CLASSIFIED EMPLOYEES Name (Last, First) Type of Leave: ☐ Sick Leave ☐ Personal Necessity: Under all circumstances, an employee shall verify in writing that sick leave for personal necessity was not used for vacation, recreation, seeking or engaging in other employment, to extend a holiday or weekend, or for concerted activities against the District. (Initial) ☐ Bereavement Relationship: ☐ Personal Deduction (full daily deduction) ☐ Union Business (specify): ☐ School Business (specify): ☐ Vacation ☐ Workers Comp ☐ Comp Time ☐ Other (specify): Site: Physician’s Certification: Normally required for absences of more than 5 days. May be required for any absence if requested by the Administrator. FROM DATE TO DATE / / / / # of Days Hrs/Day Total Hours I CERTIFY THAT THE INFORMATION STATED ON THIS FORM IS TRUE. Office Use Only Substitute Name: EMPLOYEE SIGNATURE DATE PRINCIPAL APPROVAL DATE DEPARTMENT APPROVAL DATE # of Days Hrs/Day Total Hours Office Use Only Substitute Name: Personal Illness and Personal Necessity absences reported on this form are charged against the employee’s sick leave bank.