Request for Leave Without Pay
A leave without pay of 1-3 days can be approved by your supervisor without additional approval from Human Resources/the Superintendent. Complete this form to request between 4 days and one year of leave without pay. 

All requests require supervisor approval prior to the submission of this form. For specific guidelines regarding leave without pay, see Article 18 of the Licensed CBA or Article 12 of the Classified CBA.
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Email *
Name *
Position Group *
Requested leave dates *
Leave Request Details
If you or your dependent(s) are experiencing domestic violence, harassment, sexual assault, or stalking and you need to request leave, please contact HR directly at 503-732-6842. There are paid leave options that may be applicable in your situation.
Purpose of leave without pay: *
Provide additional information regarding the reason for your leave request: *
Supervisor approval is required for leave without pay. Type the name of your supervisor and the date you received their approval below.  *
Employees out on leave are required to turn in their technology and will not be able to access their buildings or engage in work tasks until they return.  *
If your Leave Without Pay extends to two weeks or longer, your salary contract will be reconciled and suspended to make sure you are paid as much as possible and don't owe money off future paychecks once you return. 

When you return to your position your salary contract will be recalculated based on the time remaining in the school year. 
 *
If your Leave Without Pay extends to 30 days or longer your benefits will be suspended. Options for benefits while out on leave without pay can be found in your appropriate Collective Bargaining Agreement. *
What is the best method for contacting you while you are out on leave? *
Required
Thank you.
Human Resources staff will contact you with additional questions and/or to let you know the leave without pay decision.

If you have questions about this form or need more information, please contact your assigned HR Specialist:

Administrators, Supervisors, Coordinators, Directors, Confidential, Licensed Staff - Julie Baumann 
  • julie.baumann@orecity.k12.or.us
  • 503-785-8427 (internal extension 7027)
Classified Staff - Mary McGlothlan
  • mary.mcglothlan@orecity.k12.or.us
  • 503-785-8421 (internal extension 7021)

A copy of your responses will be emailed to the address you provided.
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