Fillable SABBATICAL/PROFESSIONAL IMPROVEMENT LEAVE FOR CERTIFICATED EMPLOYEES

Fill Online, Printable, Fillable, Blank SABBATICAL/PROFESSIONAL IMPROVEMENT LEAVE FOR CERTIFICATED EMPLOYEES Form

Use Fill to complete blank online OTHERS pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

SABBATICAL/PROFESSIONAL IMPROVEMENT LEAVE FOR CERTIFICATED EMPLOYEES

On average this form takes 18 minutes to complete

The SABBATICAL/PROFESSIONAL IMPROVEMENT LEAVE FOR CERTIFICATED EMPLOYEES form is 3 pages long and contains:

  • 4 signatures
  • 25 check-boxes
  • 46 other fields

Country of origin: OTHERS
File type: PDF

BROWSE OTHERS FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Distribution: 1. Original - OTM, Employee Records and Transactions Section, Certificated Unit; 2. Copy 1 - School/Office; 3. Copy 2 - Employee
(Page 1 of 3)
DEPARTMENT OF EDUCATION
Office of Talent Management
Employee Records and Transactions Section
P.O. Box 2360 Honolulu, HI 96804
I. EMPLOYEE INFORMATION
Name: ________________________________________________________________ Last 4 digits of SSN: _____________________
Last First M.I.
Position: ___________________ School/Office: ___________________________ School/Office Tel #: _______________________
Home Address: ___________________________________ City: ____________________ State: ______ Zip: ___________
Home Tel #: __________________________ Cell Tel #: ___________________________
II. LEAVE REQUEST
Type of Leave Requested (mark one):
Sabbatical Leave (Teachers only) Professional improvement leave without pay
Professional improvement leave with pay (Educational Officers only)
Professional improvement leave without pay - Extension
Leave request from _______________________ to _______________________ .
Teachers:
Semester I Semester II
School Year
School Level EO's:
Semester I Semester II
School Year
State/District EO's:
Up to 30 days
6 Months School Year
III. GENERAL INFORMATION
Period of Service with DOE:
Total: _______ Years _______ Months Teacher: ______Years ______ Months EO: ______Years ______ Months
Indicate current assignment and other duties (including subject and grade-level, if applicable):
_________________________________________________________________________________________________________
List professional improvement and sabbatical leaves previously taken or applying for (attach a separate sheet if necessary):
Type of Leave: _____________________________________ From: _______________________
To: _______________________
Type of Leave: _____________________________________ From: _______________________
To: _______________________
Type of Leave: _____________________________________ From: _______________________
To: _______________________
Type of Leave: _____________________________________ From: _______________________
To: _______________________
Type of Leave: _____________________________________ From: _______________________
To: _______________________
Mark one:
MM/DD/YYYY
MM/DD/YYYY
SABBATICAL/PROFESSIONAL
IMPROVEMENT LEAVE FOR
CERTIFICATED EMPLOYEES
Former DOE Form(s): DOE OHR 100-001
DOE OTM 100-001
Last Revised: 10/30/2018
For EOs only, if requesting professional improvement with pay up to thirty (30) days with no additional costs to the Department, please
stipulate resources:
Distribution: 1. Original - OTM, Employee Records and Transactions Section, Certificated Unit; 2. Copy 1 - School/Office; 3. Copy 2 - Employee
(Page 2 of 3)
Mark one:
Accepted in a College Program
Applied for acceptance in a College Program
Planning to apply for acceptance in a College Program
Completing a DOE Approved Program of Study
I plan to complete the following DOE Approved Program of Study:
___________ / ___________________________________ at ________________________________________________________
No. of Semester
Attach to this application a complete description of the proposed program of study indicating:
1. The purpose of this leave.
2. A statement regarding your professional development plan (for EO positions).
3. The specific objectives to be achieved.
4. Activities to achieve objectives.
5. A listing of college courses by number title and description (including alternate courses), if appropriate.
6. Evaluation of leave and how training will be used upon return to job assignment and to include official transcripts to verify
completion of course work, if applicable.
7. A research/special project submitted as a proposed program of study must (a) be approved by the Department (b) indicate a DOE
supervisor and (c) substantiate spending at least the equivalent of one-half (1/2) of the leave period to complete the project.
8. Travel requirements for Professional Improvement Leave Without Pay only:
Seventeen (17) weeks of travel are required for one (1) year leave and eight and one-half (8 1/2) weeks of travel for a one (1) semester
leave. This leave proposal must indicate dates and places to be visited and how students will benefit from your participation in
this leave.
Signature of Applicant: _______________________________________ Date: _______________________
DOE OTM 100-001
Credits
In the event that this leave is granted, I understand that the requirements must be completed during the approved leave period and agree
to abide by the Department Procedures and Regulations #5400, #5401, #5406, & #5407.
Accredited College/University
IV. PROPOSED PROGRAM OF
Former DOE Form(s): DOE OHR 100-001
Last Revised: 10/30/2018
Degree
click to sign
signature
click to edit
Distribution: 1. Original - OTM, Employee Records and Transactions Section, Certificated Unit; 2. Copy 1 - School/Office; 3. Copy 2 - Employee
(Page 3 of 3)
V. APPROVAL
To be completed by the Principal/Immediate Supervisor
Recommend: Approval
Disapproval (Provide reason(s) for denial)
Supporting Comments: ______________________________________________________________________________________
Was a final performance evaluation given? (EOs only)
Yes - Date of evaluation: __________________
No - Please give reason: ________________________________________________________________________________
Principal/Immediate Supervisor Signature: _____________________________________ Date: ____________________
To be completed by the Complex Area Superintendent, Assistant Superintendent or Designee
For up to thirty (30) day professional improvement leave with pay and no additional costs to the Department.
Approved
Disapproved (Provide reason(s) for denial)
Supporting Comments: ______________________________________________________________________________________
My signature indicates that I reviewed the completed form and discussed the implications and funding (if applicable) for this leave
with the supervisor and/or the applicant.
Complex Area Superint./
Asst Superint./Designee Signature: ____________________________________________ Date: ______________________
To be completed by the Superintendent of Education or Designee
Approved
Disapproved
Superintendent of Education/Designee Signature: _________________________________ Date: ______________________
MM/DD/YYYY
MM/DD/YYYY
My signature indicates that I discussed the implications and funding if applicable for this leave with the applicant.
MM/DD/YYYY
DOE OTM 100-001
MM/DD/YYYY
Last Revised: 10/30/2018
Former DOE Form(s): DOE OHR 100-001
click to sign
signature
click to edit
click to sign
signature
click to edit
click to sign
signature
click to edit
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

SABBATICALPROFESSIONAL IMPROVEMENT LEAVE FOR CERTIFICATED EMPLOYEES

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 18 November 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document