Application for Use of Days from Catastrophic Leave Bank
Email address *
Phone (Home)
Your answer
Phone (Cell)
Your answer
Building
I wish to apply for _____ days (maximum of 10 days per application, can be half days and full days)
Your answer
The dates I am requesting are for the following days
Your answer
Statement of Circumstances (Be specific; non-specific request automatically denied) you must email documentation to clb@usd480.net as specified in the current Negotiated Agreement, Catastrophic Leave Bank Rules, Section D, Article 5) Please select one of the following
The employee for whom the request is made is participating member of the Catastrophic Leave Bank and is an employee of the district in the following capacity.
I am aware of the provisions and limitations of the Catastrophic Leave Bank as stated in the agreement.
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