Requested Leave. The Board, upon written request of a teacher, may grant a leave of absence for up to one (1) year for any reason. The leave may be with or without compensation, and with or without insurance, at the discretion of the Board.
Requested Leave a. Fringe benefits will be paid through the month following the month of the start of the leave.
Requested Leave. (Last Working Date) (Expected Date of Return) ANY ADJUSTMENT IN THESE DATES REQUIRES REAPPLICATION SPECIFIC REASON FOR REQUEST: (Please include additional page if necessary) I HAVE READ AND UNDERSTAND THE PROCEDURES AND POLICIES UNDER WHICH MY LEAVE IS REQUESTED. (Employee Signature) (Date) RECOMMENDATION OF SUPERVISOR: Approved Not Approved (Supervisor Signature) (Date) PLEASE COMPLETE AND RETURN TO: OFFICE OF HUMAN RESOURCES RE-1J HUMAN RESOURCES RECOMMENDATION: Approved Not Approved (Signature) (Date) BOARD ACTION: Approved Not Approved (Board President) (Date) Both sides must be completed Page 1 of 2 I, , understand that I am eligible to continue my District health insurance, at my expense, for up to one year, while on authorized leave with Montrose County School District. I understand monthly premiums must be paid by the 15th of each month or coverage will be cancelled. No further notice for premium payment will be sent. I ELECT to continue coverage (at my expense) I ELECT NOT to continue coverage (COBRA information will be sent by Plan Administrator) Signature Date HR Department Representative Date Payroll Department Representative Date Addendum G Montrose County School District RE-1J Catastrophic Leave Bank Application Form This application form must be filled out completely; incomplete forms will be returned. Application should be submitted to Human Resources at District Office. Member Information (Please Print): Last Name First Middle Employee ID # (from HR) Mailing Address City State Zip Code Assigned Site (School)/ Position Telephone Number (Home/Cell) Telephone Number LIST NAMES OF THE PATIENT’S ATTENDING PHYSICIAN(S): Name Business Address Business Phone Name Business Address Business Phone I have days of leave. (Note: Leave days are the total days already accumulated and those that will accrue throughout the current contract year.) I am applying to the Catastrophic Leave Bank for number of days. I am requesting CLB days due to the death of my spouse, child or legal dependent. Authorization for Verbal Release of Protected Health Information My signature below constitutes my acknowledgement and permission for the Catastrophic Leave Bank Committee to obtain the health care information they need from my physician(s) in order to process my request for days from the Catastrophic Leave Bank. I understand that I may revoke this Authorization in writing at any time. However, my revocation will not apply to information already supplied by my physician(...
Requested Leave. Such payment or reimbursement is at the discretion of the district administration.
Requested Leave. 42 Up to five (5) days of paid non-accumulative teacher requested leave may be used 43 by each teacher per school year. The leave may be taken by the teacher without 44 loss of pay or other benefits, with the following provision:
Requested Leave. 42 Up to five (5) days of paid non-accumulative teacher requested leave may be used 43 by each teacher per school year. The leave may be taken by the teacher without 44 loss of pay or other benefits, with the following provision:
