LRUHS personal leave request

LAKE REGION UNION HIGH SCHOOL
TEACHER PERSONAL LEAVE REQUEST FORM

Date Received: _____________
Office Personnel Please Note:

Received By: ______________

DATE: __________________

NAME: ______________________________ EMPLOYER :__________________

I am requesting personal leave on for the following date(s) ________________________.

The reason for requesting this leave is:
_______ Personal Business

______ An Emergency requiring immediate attention

_______ Other Responsibilities which cannot be conducted outside of my normal work schedule

I further declare, under the terms of the Master Agreement which governs my individual contract, that this leave shall not be used for social affairs, pleasure trips, recreation, appointments with medical doctors for personal health reasons, conducting matters related to outside business interests, or other responsibilities which can reasonably be conducted outside of my normal work schedule.

Signature:

Date:

_____ Personal Leave Granted

Principal or Director:

Date:

***** Please Send Copy to Central Office *****