Redress Sought. 7. Signature(s) of Aggrieved Party(ies):
8. Date filed: STEP ONE (Building Principal)
1. Disposition by Principal: Signature of Principal Date
2. Position of Aggrieved Party(ies): Signature Date STEP TWO (Superintendent)
1. Disposition by Superintendent: Signature of Supt. Date
2. Position of Party(ies):
Redress Sought. Signature of Aggrieved Person Date
Redress Sought. Date Responder’s signature
Redress Sought. Signature(s) of Aggrieved Party(ies):
Redress Sought. Response: Date Signed
Redress Sought. The immediate supervisor will communicate his/her decision to the grievant in writing within ten (10) days of receipt of the written grievance. A copy of the grievance and the response will be forwarded to the Association President.
Redress Sought. Signed Date AGGRIEVED 7. RESPONSE: Signed Date
Redress Sought. Grievant’s Signature
4. Response:
Redress Sought. Response: Position
Redress Sought. Signature of Aggrieved Person Date 7: Response: APPENDIX D: SICK BANK APPLICATION & INSTRUCTIONS SICK BANK APPLICATION INSTRUCTIONS
1. This application must be filled out in its entirety. Please print or type all information. Incomplete applications will be returned for further clarification and will delay possible use of sick bank days.
2. Please deliver the Certification of Health Care Provider form to your medical provider. After completing the form, your provider should return the form to you.
3. You may send the completed Certification of Health Care Provider directly to the Human Resources Director or you may attach it to your application. However, your application will not be processed until the Human Resources Director receives the Certification of Health Care Provider.
4. If you have any questions regarding your application or status please contact the Superintendent’s Office at (000) 000-0000. The sick leave bank is designed to provide income protection for eligible employees who have exhausted their personal and sick leave, and who have an absence due to a personal or family catastrophic illness that prohibits them from performing their job or an alternative work assignment (if available). Sick leave bank days are not available for absences covered by workers’ compensation or for elective surgery that is not medically necessary.
SECTION I: CONTACT INFORMATION
SECTION II: REASON FOR REQUEST TO WITHDRAW DAYS FROM SICK BANK APPENDIX D: SICK BANK APPLICATION & INSTRUCTIONS (CONTINUED) SICK BANK APPLICATION FORM
