Application for Use of Days from Catastrophic Leave Bank 2019-2020
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Email address
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Your email
Phone (Home)
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Phone (Cell)
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Building
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Liberal High School
Eisenhower Middle School
Seymour Rogers Middle School
Cottonwood Elementary School
Sunflower Elementary School
Meadowlark Elementary School
MacArthur Elementary School
Praire View Elementary School
Bright Start Early Learning Center
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
kristyn.reust@usd480.net
as specified in the current Negotiated Agreement, Catastrophic Leave Bank Rules, Section D, Article 5) Please select one of the following
Major non-elective surgery
Major illness which requires hospitalization and/or convalescence or recuperation in an extended care facility or at home
An accident which requires hospitalization and/or convalescence or recuperation in an extended care facility or at home.
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.
Full Time Certified Employee
Part Time Certified Employee
Clear selection
I am aware of the provisions and limitations of the Catastrophic Leave Bank as stated in the agreement.
Yes
No
Clear selection
Send me a copy of my responses.
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