EMPLOYEE’S SECTION. I hereby authorize my physician to release the foregoing information (including any explanation arising from the information provided) concerning my current illness or injury to my Employer, the Regional School Board. It is understood that this information be only of the same nature and extent as is provided under A of this form and does not authorize the release of informa- tion which is different in nature or greater in extent. I understand that I will receive a copy of any medical information received by the Board from my physi- cian. Teacher’s Signature Date APPENDIX TERM SERVICEFORM AS PERARTICLE LOCALCONTRACT Name: Prof. According to the Local Agreement we will be generating a Seniority List for all and part-time term teachers. We have calculated your seniority to be: July (previous school year) Aug. July (current school year) Service Aug. July Recognized Service Prior to August Total Service July The following is the criteria and the staffing rounds that apply to term teachers: Round Terms with two (2) term positions (2-Year Terms) that are currently in a position that still exists and is substantiallythe same are placed. Please note term teachers do not have to be in the same position for two (2) consecutive years. Round Terms with days in each of two (2) consecutive years, Year Terms not previously placed, and all terms with days. Round External advertisement.All terms eligible to apply, as well as outside applicants. According to your term service calculated above, the following Round will apply to you: If we have indicated Round is applicable to you, please note you will only be placed in this round if you meet the above criteria. If you do not meet the above criteria, then you will be eligible to apply in Round Please return a copy of this form signed by (indicate date). I acknowledge that the above information is and will remain the basis for placement for the coming school year. Yes, I agree with the above information. If you the above information is incorrect, please what you feel your service should be and why, and forward this information to the Corporate Ser- vices Department, Human Resources Division, and your Local Union Presi- dent. Signature of Teacher APPENDIX
EMPLOYEE’S SECTION. I hereby authorize my physician to release the foregoing information (including any explanation arising from the information provided) concerning my current illness or injury to the Tri-County Regional School Board. I understand that I will receive a copy of any medical information received by the Board from my physician. Teacher’s Signature Date cc: Superintendent of Schools, Tri-County Regional School Board APPENDIX B Request for Functional Information of Presenting Illness/Injury Tri-County Regional School Board 00 Xxxxx Xx., Xxxxxxxx, XX X0X 0X0 Phone: 000-0000 Fax: 000-0000 The Tri-County Regional School Board has developed a return to work program to assist employees in their rehabilitation and return to full health and employment. Part of the process is to get information about your current abilities from your physician as it relates to your illness/injury. To do this we ask that you have your physician complete this form.
EMPLOYEE’S SECTION. I hereby authorize my physician to release the foregoing information as well as any follow up information concerning my current illness or injury to the South Shore Regional School Board for the purpose of developing a safe return to work plan. The Employer will keep this information confidential. It is understood that this information shall only be of the same nature and extent as disclosed in this form and does not authorize the release of information which is different in nature or greater in extent. I understand that I will receive a copy of any medical information and be made aware of any further requests for medical information by the Board. Employee Signature: Date:
EMPLOYEE’S SECTION. I hereby authorize my physician to release the foregoing information (including any explanation arising from the information provided) concerning my current illness or injury to my Employer, the Annapolis Valley Regional School Board. I understand that I will receive a copy of any medical information received by the Board from my physician Teacher's Signature Appendix B
EMPLOYEE’S SECTION. This evaluation has been discussed with me and I have been offered the opportunity to comment on it. Employee’s signature: Date: I concur with the evaluation I do not concur with the evaluation Employee Comments:
EMPLOYEE’S SECTION. I hereby authorize my physician to release the foregoing information (including any explanation arising from the information provided) concerning my current illness or injury to my Employer, the Atlantic Provinces Special Education Authority. I understand that I will receive a copy of any medical information received by the Board from my physician. Teacher’s Signature Date APPENDIX D
EMPLOYEE’S SECTION. I hereby authorize my physician to release the foregoing information (including any explanation arising from the information provided) concerning my current illness or injury to my Employer, the Chignecto-Central Regional School Board. It is understood that this information be only of the same nature and extent as is provided under Part A of this form and does not authorize the release of informa- tion which is different in nature or greater in extent. I understand that I will receive a copy of any medical information received by the Board from my physi- cian. Teacher’s Signature Date APPENDIX “B” TERM SERVICE FORM AS PER ARTICLE 14 OF THE REGIONAL CONTRACT Name: Prof. # According to the Local Agreement we will be generating a Seniority List for all 100% and part-time term teachers. We have calculated your seniority to be: Aug 1, 20 - July 31, 20 (previous school year) Aug. 1, 20 - July 31, 20 (current school year) Service - Aug. 1, 20 - July 31, 20 Recognized Service Prior to August 1, 20 Total Service - July 31, 20 The following is the criteria and the staffing rounds that apply to term teachers:
EMPLOYEE’S SECTION. I hereby authorize my physician to release the foregoing information (including any explanation arising from the information provided) concerning my current illness or injury to my Employer, the Regional School Board. understand that I will receive a copy of any medical information received by the Board from my physician. Teacher’s Signature Date Regional School Board Agreement APPENDIX TERM SERVICE FORM AS PER ARTICLE OF THE LOCAL CONTRACT Name: Prof. According to the Local Agreement we will be generating a Seniority List for all and part-time term teachers. We have calculated your seniority to be: July (previous school year) Aug. July (current school year) Service- Aug. July Service Prior to August Total Service July The following is the criteria and the rounds that apply to term teachers: Round Terms with two (2) term positions (2-Year Terms) that are currently in a position that and is substantially the same are placed. Please note teachers do not have to be in the same position for two (2) consecutiveyears. Round Terms with days in each of two (2) consecutive years, 2-Year Terms not previously placed, and all terms with days. Round External advertisement. All terms eligible to apply, as well as outside applicants. According to your term service calculated above, the following Round will apply to you:
EMPLOYEE’S SECTION. I hereby authorize my physician to release the foregoing information as well as any follow-up information concerning my current illness or injury to my Employer, le Conseil scolaire acadien provincial. I understand that I will receive a copy of any medical information received by my Employer from my physician and will be made aware of any further requests for medical information by the Conseil. EMPLOYEE'S SIGNATURE: DATE: VEUILLEZ VOUS ASSURER QUE CE FORMULAIRE EST REMPLI, SIGNS ET RETOURNE AU BUREAU REGIONAL-HALIFAX, D'ICI LE: Merci! APPENDIX "B" SHARED TEACHING Eligibility Participation in shared teaching is available to teachers in the employ of the Board. Percentage , Shared teaching is only possible on a fifty percent (50%) fifty percent (50%) basis. Certificate One of the shared teachers must have a permanent contract with the Board.
EMPLOYEE’S SECTION. I hereby authorize my physician to release the foregoing information as well as any follow-up information concerning my current illness or injury to my Employer, le provincial. I understand that I will receive a copy of any medical information received by my Employer from my physician and will be made aware of any further requests for medical information by the Board. EMPLOYEE’S SIGNATURE: DATE: ASSURER QUE FORMULAIRE EST ET A BUREAU AVANT LE: Collective APPENDIX SHARED TEACHING Eligibility Participation in shared teaching is available to teachers in the employ of the Board.
