Fillable Printable Child Care Leave Form - Spackenkill Union Free School District
Fillable Printable Child Care Leave Form - Spackenkill Union Free School District
Child Care Leave Form - Spackenkill Union Free School District
SpackenkillUnionFreeSchoolDistrict
CHILDCARELEAVEFORM
Iplanto use ______ days (upto 40) ofmy accumulated
sick leave for pregnancyrelated disability(letter of request
to the Superintendent and a doctor’snote is necessary)
from_____________to _____________.
(Date)(Date)
Iplanto use Family Medical Leave to continue my
health insurance coverage fortwelveweeks
from_____________to _____________.
(Date)(Date)
(FMLA and pregnancy related disabilityrun concurrently.
Form is availablein Personnel Manual and submitted
to the Superintendent.)
Iplanto use unpaid child care leave
from_____________to _____________.
(Date)(Date)
_________________________ ____________
SignatureDate
