CERTIFICATED STAFF

PERSONAL LEAVE REQUEST FORM

Unit Member ___________________________________________________________

Building _______________________________________________________________

Date of Request _________________________________________________________

Day(s) and date(s) for which leave is requested ________________________________

Personal leave is to be used in accordance with the following provisions:

Written request on the form as herein incorporated, must be given to the principal/supervisor for acknowledgment and to the Superintendent at least five (5) days prior to the requested date, except in emergencies. In emergency situations, the form shall be submitted as early as possible.

Personal leave shall be used in one-half (1/2) or one (1) day increments.

Approved personal leave shall be at regular pay.

Personal leave may not be accumulated from year to year.

The personal leave shall require a signed certification that the leave will not be used for vacation, for seeking or engaging in gainful employment.

Except in special circumstances, which must be explained in writing, personal leave shall not be used to extend a holiday or vacation period.

Personal leave will be approved provided that all provisions of this article have been met.

However, no more than five (5) percent of any building may use personal leave on a given day except by prior agreement when a position can be covered with a substitute.

I hereby certify that the above personal leave will be/was used for an appropriate reason. I understand that a violation of this certification of the use of personal leave for a reason prohibited by Section (5) of the personal leave article constitutes grounds for suspension or termination.

_______________________________________ ________________________________

Unit Member’s Signature Superintendent’s Signature

_______________________________________ ________________________________

Principal’s Acknowledgment Date