Application for Use of Days from Catastrophic Leave Bank 2019-2020
Email address *
Phone (Home)
Phone (Cell)
I wish to apply for _____ days (maximum of 10 days per application, can be half days and full days)
The dates I am requesting are for the following days
Statement of Circumstances (Be specific; non-specific request automatically denied) you must email documentation to as specified in the current Negotiated Agreement, Catastrophic Leave Bank Rules, Section D, Article 5) Please select one of the following
Clear selection
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.
Clear selection
I am aware of the provisions and limitations of the Catastrophic Leave Bank as stated in the agreement.
Clear selection
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