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CCISD RETURN TO WORK REQUEST
Request must be approved by the Personnel Office prior to returning to work.
You and your supervisor must have written authorization before returning to work. Both parties will receive an email.  Updated per local guidance 1/3/22
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Employee Last Name *
Employee First Name *
Employee Phone contact *
Dates Absent *
Campus/Department *
Required
Requesting to return on what date: *
MM
/
DD
/
YYYY
Date Positive
MM
/
DD
/
YYYY
Return to Work: Negative Results
Clear selection
Employee Test- to- stay: Household Exposure *
Required
Employee Request for opt-out of Test-To-Stay: Household exposure I will provide the following information from my healthcare provider: Signed and dated return to K. Taylor or Cynthia Partida *
Required
Employee Signature/Date: (Type name & date below) *
Submit
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