Personal Leave Form printable pdf download

P E R S O N A L

L E A V E

A P P L I C A T I O N

( S A G E S ,

G N T A , O S A ,

A D U L T

E D

P A R A P R O F E S S I O N A L )

NOTE: SIR, TESL & hourly teachers who work less than 5 days a week are not entitled to personal leave days.

Name: _________________________________________ Today’s Date: _________________________________

(Print or Type)

Bargaining

School/Location:____________________ Position: _____________________ Unit:________________________

SAGES, GNTA, OSA & PARAPROFESSIONAL

(Before completing this form, refer to reverse side of this form for important information regarding requests that

immediately precede/follow summer, Thanksgiving, Christmas, winter and spring vacations.)

Day(s) of

Date of Personal Leave Day being requested: ______________________ Week: _________________

(mm/dd/yyyy)

_____ This is my first request this school year.

_____ This is my second request this school year. My first personal day was taken: ________________

(mm/dd/yyyy)

_____ This is my ______ request this school year (reason provided on back).

I certify the above request is consistent with the criteria outlined in my bargaining unit’s agreement as it pertains to

personal leave days.

Signature of Requestor:_______________________________________

ADULT EDUCATION

Applicable to members who:

(a) teach in the Adult Basic Education Program, or

(b) teach more than 24 hours per week in the Adult Education Program

Total number of hours entitled to this school year

(see contract for percentages and maximums):

____________

Total number of hours used to date this school year:

____________

Number of hours being requested at this time:

____________

Date these hours will be taken:

____________________

(mm/dd/yyyy)

Number of hours remaining this school year:

____________

I certify the above request is consistent with the criteria outlined in my bargaining unit’s agreement as it pertains

to personal leave days.

Signature of Requestor:_______________________________________

(See reverse side)

Personal Leave Form

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