Fillable BRYANT SCHOOL DISTRICT LEAVE OF ABSENCE NOTIFICATION/REQUEST FORM (City of Oakland)

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BRYANT SCHOOL DISTRICT LEAVE OF ABSENCE NOTIFICATION/REQUEST FORM (City of Oakland)

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BRYANT SCHOOL DISTRICT
LEAVE OF ABSENCE NOTIFICATION/REQUEST FORM
Name
Last 4 digits SSN
Date
Position School/Department
Date
Days/Hrs
AM/PM
Pays for Sub
Sick Leave (110)
Personal illness, Immediate Family, Death of relative - Policy 3.8, 8.5
District
Sick as 3rd Personal (110)
Sick leave used as 3rd personal-must have 5 yrs. Experience w/Bryant
District
Personal Leave (115)
Two days per year - Policy 3.11, 8.7
District
Professional Leave (125)
Principal & Prof. Dev. Supr. must approve (indicate source of sub pmt.) - Policy 3.11, 8.7
District
Military Leave (126)
Policy 3.8.2, 8.6.2
Employee
Jury Duty (127)
Policy 3.14, 8.10
District
School Business (128)
Field Trips, Committee Mtgs., etc. (indicate source of sub pmt.) - Policy 3.8.2, 8.6.2
Court Subpoena (129)
Policy 3.14.1, 8.10.1
District
One-Hour Early Leave (130)
Limit three (3) times per year for medical reasons - Policy 3.8, 8.5
N/A
Funeral Leave (135)
Maximum of a two (2) hour absence to attend funeral - Policy 3.8.1, 8.6.1
N/A
Bereavement (140)
Policy 3.8.1, 8.6.1 - Up to three (3) days for death of specific family members
District
Sick Leave Bank (145)
Must be a Member & have committee approval - Policy 3.9, 8.6
District
Leave Without Pay (160)
Non-approved absences
District
Vacation (165)
Twelve (12) month employees - Policy 3.46, 8.38
N/A
Family Medical Leave (166)
Leave for care of child, spouse, parent, or a serious health condition-Policy 3.8, 3.32, 8.23
District
COVID Leave
COVID Leave - Working Remote (Approved by Supervisor)
COVID Leave
COVID Leave - Not working
Explanation of Request
(Please be detailed in your description.)
Professional Development Leave: Complete the information for approval and send to the Director of Professional Development, Athletic Director,
Special Education Supervisor or Gifted & Talented Coordinator at least two (2) weeks in advance of Professional Development date. Attach
appropriate documentation, such as a copy of conference registration form, copy of conference/in-service agenda or brochure. Approved PD
hours during a student interaction day will not count toward the 10 non-student interaction days.
Purchase Orders MUST be attached detailing all anticipated costs.
Title and Description of Professional Development:
Location:
Date of PD:
Time of PD:
Will a Sub be Needed?
YES
NO
All Leave Request
Employee's Signature
Principal/Supervisor Signature
Approved Disapproved Date
Professional Development Approval:
Approved Disapproved
Director of Professional Development/Deputy Superintendent
Superintendent
Approved
Disapproved
Date
(see NOTE)
NOTE: Policy 3.11 & 8.7 - Personal leave for more than two (2) consecutive days OR the day before or the day after a holiday require prior approval of Superintendent.
form updated 9/15/2020
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BRYANT SCHOOL DISTRICT LEAVE OF ABSENCE NOTIFICATIONREQUEST FORM (City of Oakland)

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Completed 10 January 2021

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