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Request for Leave of Absence Form

The document is a Request for Leave of Absence Form that must be filled out and returned at least two days prior to the requested absence. It outlines the types of absences, responsibilities for finding substitutes, and the conditions under which personal and sick days can be used. Additionally, it includes a section for office use to record approvals and other administrative details.

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Pedro Perez
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9 views1 page

Request for Leave of Absence Form

The document is a Request for Leave of Absence Form that must be filled out and returned at least two days prior to the requested absence. It outlines the types of absences, responsibilities for finding substitutes, and the conditions under which personal and sick days can be used. Additionally, it includes a section for office use to record approvals and other administrative details.

Uploaded by

Pedro Perez
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Request for Leave of Absence Form

Please fill out this form and return it to the office


at least 2 days prior to your requested absence.
Date(s) of Absence: Teacher Name:
Date Information of the Absence Reason for Absence(s)

Full Day
Personal Reasons
Morning List time:
School Related Immigration Issues
Afternoon List time:
I will need a substitute. Immigration Issues unrelated to school
I have arranged for internal coverage. Professional Development (approval required)
Please detail here: School related activity:
Illness (for you or immediate family member)
Medical/Dental appt. (for you or immediate
family member)
Family Crisis (regarding immediate family)
Secondary teachers: Select all scheduled teaching Vacation (for office staff)
periods/Study Halls you will miss: Other: Please list:

1 2 3 4 5 6 7 DS

DUTIES: Finding subs for your duties is YOUR Signature:


responsibility. Please indicate your duties and list
subs that you have found below.
Please fill out the Substitute Information Form
and give it to your PRINCIPAL at least 1 full day
Morning – Location: Sub:
Afternoon – Location: Sub: before your absence.
Recess/Lunch – Location: Sub:
Other – Location: Sub:

*I understand that I have two personal days per year to use at my discretion. I also understand that the Director has the right to deny the use of these days
if it is in the best interest of the school.
*I understand that I have 18 sick days per year or prorated according to work load. I understand that I need to turn in a doctor’s note to confirm my
absence.
*The school reserves the right to count any absence that is not accompanied by a doctor’s note as an unexcused absence.
*Unexcused absences will result in deductions to an employee’s monthly pay.
For Office Use Only
Personal Day: Approved Denied Absence is: Excused Unexcused Sick Day Vacation School Act.
Substitute: ____________________________________ Sub Pay Requested: ¨ Yes ¨ No Sec’y Initials: _____________
Notes :________________________________________________________________________________________________
Administrative Signature: ______________________________________ Date: ____________________________
Absence has been recorded in FACTS Pay Reduction Applied ¨ Yes ¨ No
Initials of Secretary ________ Date __________ Business Office Initials ________ Date_________

7/26/2019; Rev. 8/11/19

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