San Diego Unified School District Jury Duty Postponement Form


San Diego Unified School District
Jury Duty Postponement Form
Instruction: Non-management contracted certificated employees requesting
compensation for postponement of jury duty to a time when they were not required to
render service to the district, please submit form to the Payroll Department, Room
1150, Education Center, 4100 Normal Street, San Diego, CA 92103.
Employee Name (Last, First)
Employee ID Number
Location #
School or Department
Subject, grade or position
(1) Original Jury Duty Reporting Date
(Copy of original notice must be attached)
(2) Actual dates of Jury Service (Original Official Court
Validation of Jury Duty served must be attached)
(3) Of the actual dates of Jury Service completed (Line 2),
Please list dates that were non-contract days for which
Jury Duty postponement compensation is requested.
Total Number of Days
See District procedure No. 7144 and Jury Duty
For Payroll Use Only
Provisions Contained in the Leave Policies article
of the Collective Negotiations Contract for
No. of Days
Certificated Employees
Rate of Pay
Total Paid
Pay Date
Employee Signature
Revised 3/14/05


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