Fillable Child Care Leave Of Absence Application (Unpaid) – Instructional Staff Only (City University of New York)

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Child Care Leave Of Absence Application (Unpaid) – Instructional Staff Only (City University of New York)

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APPLICATION FOR SPECIAL LEAVE FOR CHILD CARE (UNPAID)
INSTRUCTIONAL STAFF ONLY
OHRM -Special Leave for Child Care (Unpaid) Form - 12-10-18
Contract Title
Empl. ID
Department
Name
Employee Information:
Supervisor's Name
Phone
End Date
Date
Signatories are for notification purposes per campus procedure:
Date
Human Resources
Date
President
Date
Date
End Date
Begin Date
I am requesting an extension of Special Leave for Child Care (Unpaid):
I am requesting Special Leave for Child Care (Unpaid):
Address
City
State
Zip
Phone
email
Child's birth certificate or supporting affidavit of legal responsibility is attached
I understand the conditions that apply to this leave.
Special leaves for the purpose of caring for a newborn infant shall be granted to a member of the Instructional Staff upon notification to the President and
application for such leave, provided the applicant has legal responsibility for the care and/or support of said child.
- The duration of the leave shall ordinarily be for one full semester (6 months for non-teaching instructional staff).
- In exceptional cases, the President may terminate such leave during the college term, provided there is an appropriate opening in which the
applicant's service may be utilized.
- An extension of such leave shall be permitted on request for a period not in excess of one year from the end of the original leave. No further extension
shall be permitted.
- Leaves for the purpose of caring for a newborn infant shall be granted without pay during the period of the leave, including the vacation period
concomitant to the leave. If the leave is for one semester only, the loss of paid vacation shall be for one month only. If the leave is for two semesters,
both months of vacation shall be without pay.
- If the duration of the leave is less than one calendar year, it shall be credited toward salary increments; if it is one calendar year or more, it shall not be
credited towards salary increments.
- When the service of a member of the Instructional Staff is interrupted by reason of absence on a leave for the purpose of caring for a newborn infant,
the period of creditable service immediately preceding such absence shall be counted in computing the years of service required for the granting of
tenure, a certificate of continuous employment (CCE), or for a certificate of continual administrative service in the Higher Education Officer series title
(13.3b).
- Employees who are on leave without pay do not receive benefits (health insurance) and are not eligible for retirement credit while on leave.
Employee completes form and submits to Dept. Chair/Supervisor.
Human Resources' signature required.
Vice President
School Dean
Dept. Chair/Supervisor
Date
Noted:
College
Signature
Signature
Signature
Signature
Signature
Signature
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Child Care Leave Of Absence Application (Unpaid) Instructional Staff Only (City University of New York)

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Completed 18 December 2020

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