EMPLOYEE'S STATEMENT. I hereby authorize Xxxxxx Public Schools to contact my health care provider(s) to verify the reason for my requested leave or for any other information concerning my requested family or medical leave. I understand that this authorization will be used only if a medical certification is not received or it is incomplete. I understand that a failure to return to work at the end my leave period may be treated as a resignation and will serve as a basis for discharge unless an extension has been agreed upon and approved in writing by . Date Employee's Signature Approved by: Superintendent This page intentionally left blank. SAMPLE ADMINISTRATIVE FORMS 75
EMPLOYEE'S STATEMENT. 4 a. The employee shall state that such absence was due to a 5 personal necessity and outline the nature of such necessity.
EMPLOYEE'S STATEMENT. The information obtained from completion of these documents is for use in determining the employee's eligibility for a Sick Leave or required workplace accommodation. Last Name: First Name: S.I.N. #: Date of Birth: Male Female Address:
EMPLOYEE'S STATEMENT. I hereby authorize Xxxxxx Public Schools to contact my health care provider(s) to verify the reason for my requested leave or for any other information concerning my requested family or medical leave. I understand that this authorization will be used only if a medical certification is not received or it is incomplete. I understand that a failure to return to work at the end my leave period may be treated as a resignation and will serve as a basis for discharge unless an extension has been agreed upon and approved in writing by . _ Date Employee's Signature Approved by: Superintendent SAMPLE ADMINISTRATIVE FORMS L e t t e r o f C o u n s e l To: Employee, Title/Position From: Supervisor, Title Date: Consistent with the Xxxxxx Public Schools commitment to maintaining high standards and treating all employees fairly and ethically, this letter is to clearly address an issue related to your performance and/or conduct that needs to improve in order to meet the standards of the District and/or _ Department/School. It is also intended to document our previous meeting regarding this issue. As we discussed in our meeting on your performance/conduct fails or has failed to meet our standard in the following ways:
EMPLOYEE'S STATEMENT. I hereby authorize Xxxxxx Public Schools to contact my health care provider(s) to verify the reason for my requested leave or for any other information concerning my requested family or medical leave. I understand that this authorization will be used only if a medical certification is not received or it is incomplete. I understand that a failure to return to work at the end my leave period may be treated as a resignation and will serve as a basis for discharge unless an extension has been agreed upon and approved in writing by . Date Employee's Signature Approved by: Superintendent SAMPLE ADMINISTRATIVE FORMS This page intentionally left blank. Letter of Counsel To: Employee, Title/Position From: Supervisor, Title Date: Consistent with the Xxxxxx Public Schools commitment to maintaining high standards and treating all employees fairly and ethically, this letter is to clearly address an issue related to your performance and/or conduct that needs to improve in order to meet the standards of the District and/or Department/School. It is also intended to document our previous meeting regarding this issue. As we discussed in our meeting on your performance/conduct fails or has failed to meet our standard in the following ways: (Be as specific a possible. For example: You have been late to work three times from September 1 to October 5. Also, include any response that the employee offered during the initial meeting. For example, you have acknowledged that you have been late, but indicated that you did not remember being late as often as reported.) (Directive or suggestions for improvement/correction. For example: You are directed to be at your post by 8 a.m. each day.) This letter should be understood as part of our effort to work together toward the goal of achieving your success as an employee. Please approach these suggestions/directives for improvement with the understanding that the district and I are invested in you and your success. I will retain a copy of this memo, but it will not be part of your personnel file with the district. However, further steps in the progressive disciplinary process may result in documentation that would be included in your district personnel file. Rev. 10-2019 XXXXXX PUBLIC SCHOOLS SUPPORT EMPLOYEE ADMONISHMENT FORM Employee’s Name Employee’s Supervisor Employee’s Job Title Work Site Date Cause – List Violation of Negotiated Agreement 7.6. Description of Violation Has the employee been warned previously? Yes No If yes, circle f...
EMPLOYEE'S STATEMENT. The information obtained from completion of these documents is for use in determining the employee's eligibility for a Sick Leave or required workplace accommodation. Last Name: First Name: S.I.N. #: Date of Birth: Male Female Address: No. & Street City/Town Province Postal Code Telephone No.:
EMPLOYEE'S STATEMENT. I have reviewed and discussed the duties and responsibilities of this position with my supervisor and have received a copy of the Duty Statement and can perform the duties outlined above without a Reasonable Accommodation. Employee's Name (Print) Employee's Signature Date Supervisor's Statement: I have reviewed the duties and responsibilities of this position and have provided a copy of the Duty Statement to the Employee. Supervisor's Name (Print) SupeNisor's Signature Date
EMPLOYEE'S STATEMENT. The Employee hereby states that he is neither a party to any agreement or any other legal restriction which prohibits him from executing this Agreement or performing any obligation hereunder, nor bound by such agreement or any other legal restriction.
