Charles County Public Schools

CHARLES COUNTY PUBLIC SCHOOLS EMPLOYEE LEAVE STATEMENT CERTIFIED

EMPLOYEE NAME EMPLOYEE ID # SCHOOL

DATES # HOURS LEAVE DESCRIPTION ANNUAL LEAVE Twelve-month Employees only.

PERSONAL LEAVE 10-Month, 10.5-Month, and 11-Month Employees only. PLEASE NOTE: ALL INFORMATION AND/OR ATTACHMENTS ARE NECESSARY IN ORDER TO BE GRANTED ADMINISTRATIVE LEAVE.

FUNERAL - IMMEDIATE FAMILY or anyone who has lived regularly in the household. ** MAXIMUM: THE EQUIVALENT OF FIVE (5) WORK DAYS. RELATIONSHIP DATE OF DEATH

FUNERAL - OTHER limited to two (2) instances, up to two (2) days each per fiscal year RELATIONSHIP DATE OF DEATH

COURT/LEGAL SUMMONS Employee’s summons to appear as witness or verdict of not guilty MUST be attached to avoid loss of leave and/or pay.

JURY DUTY SUMMONS Daily attendance papers MUST be attached to avoid loss of leave and/or pay.

CONFERENCES, ON OR OFF-SITE MEETINGS, WORKSHOPS, IN-SERVICES, etc. EVENT LOCATION

WORKER’S COMPENSATION Sick leave charged until approved by Risk Manager.

SICK LEAVE - EMPLOYEE and/or FAMILY ILLNESS A doctor’s statement may be required after the equivalent of three (3) consecutive workdays.

RELIGIOUS and/or IDEOLOGICAL OBSERVANCE Two (2) days per fiscal year permitted (deducted fom sick leave) EACC employees only.

OTHER Specify LWOP (Leave Without Pay), etc. ______

______Total Hours Leave Requested by Employee

______Employee Signature Date

______Supervisor Signature Date

*FOR CLARIFICATION, PLEASE REFER TO THE EACC NEGOTIATED AGREEMENT.

Revised: August 2014