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Riverside Unified School District Online Classified Leave of Absence Application
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Email
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
Employee Number
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Your answer
Contact Phone Number
*
Your answer
Current School/Department Site
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Your answer
Requested Leave Type
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Choose
California Family Rights Act (CFRA) - [for baby bonding/ adoption time only]
Parenthood Leave (unpaid no benefits)
Personal Leave (unpaid no benefits)
Study Leave (unpaid no benefits)
Family Medical Leave Act (FMLA)- [for birth of a child/ adoption only]
Health Leave (unpaid with benefits)
On what date are you requesting your leave to begin? (MM/DD/YYYY)
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Your answer
On what date are you requesting your leave to end? (MM/DD/YYYY)
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Your answer
On what date are you anticipating returning to work? (MM/DD/YYYY)
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Your answer
If requesting a Personal Leave or Study Leave, please provide a reason in this application (below) and send any supporting documentation (e.g., school schedule, etc.) to Jamie Harnett, Human Resources Technician, via e-mail at
jharnett@riversideunified.org
or in-person at the District Office (3380 14th Street, Riverside, CA 92501).
Your answer
If you have any questions, please contact Jamie Harnett, Human Resources Technician, at
jharnett@riversideunified.org
.
A copy of your responses will be emailed to the address you provided.
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