Fillable Leave Of Absence With Pay Recommendation Form printable pdf download

Leave Of Absence With Pay Recommendation Form

Download a blank fillable Leave Of Absence With Pay Recommendation Form 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 Leave Of Absence With Pay Recommendation Form 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.

THE NEW YORK CITY DEPARTMENT OF EDUCATION

DIVISION OF HUMAN RESOURCES AND TALENT - HR CONNECT

OFFICE OF MEDICAL, LEAVES AND RECORDS ADMINISTRATION

65 Court Street, Brooklyn, NY 11201

Leave of Absence with Pay Recommendation Form

This form must be completed by the immediate supervisor, countersigned by the Executive Director/Director and attached to the

PD 6: Application for Leave of Absence for Health Reasons.

Employee's First Name

Empl ID#

Social Security Number

Employee's Last Name

Title

Work Location

Division

How long have you supervised this employee?

Please provide your assessment of this employee in the following areas:

Outstanding

Satisfactory Unsatisfactory

Attendance*

Cooperation

Punctuality

Reliability

*If the employee's attendance has been adversely affected by the illness which necessitates this leave, please provide your assessment of the

employee's attendance prior to this illness.

Please provide your recommendation regarding this request for leave of absence with pay and indicate specific reasons to support your recommendation. Please note

that employee's performance must be satisfactory for leave to be considered. If less than satisfactory, please explain. (Attach reason to this form, if neccessary).

In addition, in order to consider a medical leave with pay, the length and character of service must be explicitly addressed in recommendation.

I hereby approve the request for leave of absence:

with pay

without pay

(Insert comments below or attach reason)

Comments

Signature of Immediate Supervisor

Date

Signature of Executive Director/Director

Date

Leave of Absence with Pay Recommendation Form