Transfer Request Form - Credentialed School Nurse

Download a blank fillable Transfer Request Form - Credentialed School Nurse in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Transfer Request Form - Credentialed School Nurse with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

ADVERTISEMENT

Los Angeles Unified School District
DISTRICT NURSING SERVICES
Credentialed School Nurse
Request for Transfer
Name: __________________________________________
Pers ID/Emp No: ____________________________
Home
Address: ________________________________________
Telephone: Home #__________________________
_________________________________________
Cell #__________________________
Nursing Administrator: ____________________________
Email: ___________________________________
Present Position: Credentialed School Nurse
Status:
Permanent
Probationary
Length of service as a School Nurse in LAUSD: _____ yrs Duration in present nursing area: _____ yrs ____ months
List previous schools:
ES,
MS,
HS,
Other ________________________________________________
Number of previous transfer requests: ____ How many granted: ____ Date last transfer request granted: _________
:
LIST THE NURSING AREA TO WHICH YOU WISH TO BE ASSIGNED IN ORDER OF PREFERENCE
1. _________________________________________
2.__________________________________________
_____________________________________________
__________________________________________
Signature of Applicant
Signature of Director of Nursing Services
Date: ________________________________________
Date: _____________________________________
_________________________________________________________________________________________________________
Article XI-Transfers Sec 9.0 (UTLA Contract): Employee Initiated Transfers-Employees Time-reported from central or
regional locations: Any permanent Health and Human Services employee assigned from the central office, Local District office,
service center or nursing services area, who has served in paid status for at least 130 days each year for three consecutive years at
the same central or regional location from which transfer is sought may apply for a transfer.
1. Applications must be signed by the applicant and submitted to the Director of Nursing Services by April 15th. A
copy will be sent to Local District Nursing Administrator.
2. No faxed applications will be accepted.
3. Applications are valid for one (1) calendar year unless withdrawn by the applicant.
4. A completed application does not guarantee a transfer will be granted.
5. Transfers are granted based on District need.
Rev 3/4/11

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Business
Go