Appeal Form for Excessive Leave Days
Adopted: 4-4-06
Policy:
In accordance with Professional Staff Leave Policy (GCBD-A): "Employees who use more than 12 days in one contract year will have 1/183 deducted from his/her salary for each day beyond the 12 days. An exception would be an extreme long-term, medical condition verified in writing from a physician or care provider. Employees who exceed the 12 days in one contract year may appeal their circumstances in writing (accompanied with proper documentation) to the District by June 15 of that contract year. In any contract year, employees who use more leave days than they have accumulated will have l /183 deducted from their salary for each day beyond their accumulated days."
According to our District Records, ___________ has used ____ Leave Days during this contract year. If you feel this is inaccurate, please notify the District.
Appeal Form:
The following form must be completed and submitted to the District Office by June 15.
Employee's Name: _____________________________________________________________ Date: _________________________________
In the following table, list the specific days you used Leave Days and to the right provide the reason why. Make sure you include or attach documentation to support your reason(s).
List Date(s) of Leave: Reason(s):
_____________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________
Decision of Appeal: (To be completed by District)
Employee's Name: ___________________________________________________________________________________________________________
Accepted: ________________________ Denied: ______________
Reason(s): __________________________________________________________________________________________________________________
If Denied:
Total amount to be deducted will be $_________________________________. This total amount will be divided and deducted in June, July, and August Statements: $_________________ per month
District Signature: ____________________________________________________ Date: _______________________________
