"Request Form for Leave of Absence to Teach in a Charter School - Metropolitan Nashville Public Schools"

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REV 7/13
L-8
METROPOLITAN NASHVILLE PUBLIC SCHOOLS
REQUEST FOR LEAVE OF ABSENCE
TO TEACH IN A CHARTER SCHOOL
The purpose of this type of leave is to allow the employee to retain accumulated leave and continuity of service. However, it should be noted
that the District can grant leaves only for specified periods of time. Employees may be granted leave to teach in a Charter School for up to one
year. Only tenured teachers qualify for this type of leave.
THIS COMPLETED FORM L-8 MUST BE SUBMITTED TO THE OFFICE OF EMPLOYEE BENEFITS AND APPROVED BEFORE THE LEAVE IS TAKEN.
Please answer all questions as completely as possible as inadequate information can delay processing.
SECTION I – (TO BE COMPLETED BY EMPLOYEE)
(Please Print)
Name _________________________________________ Employee # ______________Phone _________________
Address _______________________________________________________________________________________
(Street)
(City/ST)
(Zip)
School/Location ___________________________________________________ Title _________________________
Date Requesting to Begin Leave _________________________ Return Date _______________________
Charter School: _________________________________________________________________________________
Hire Date: _____________________________________________________________________________________
Employee Signature: ____________________________________________________Date ____________________
SECTION II (TO BE COMPLETED BY THE PRINCIPAL/DEPARTMENT SUPERVISOR)
I Acknowledge the Following Leave Request: From _______________To ____________
Comments: _____________________________________________________________________________________
Principal/Supervisor ___________________________________Title __________________________Date _________
Signature
SECTION III – (TO BE COMPLETED BY HUMAN CAPITAL)
APPROVAL STATUS:
( ) Leave is Approved
( ) Leave is NOT Approved
LEAVE DATES APPROVED From: ______/_______/_______ To: _______/_______/_______
Comments: _____________________________________________________________________________________
Approval Signature __________________________________________________ Date ________________________
EMPLOYEES MUST NOTIFY EMPLOYEE BENEFITS IN WRITING OF THEIR AVAILABILITY TO RETURN TO ACTIVE SERVICE
TWO WEEKS IN ADVANCE OF THEIR RETURN DATE
PLEASE RETURN FORM TO METROPOLITAN NASHVILLE PUBLIC SCHOOLS EMPLOYEE BENEFITS
2601 BRANSFORD AVE  NASHVILLE TN 37204  FAX 615/214-8665
QUESTIONS CALL 615/259-8410 or 259-8641
REV 7/13
L-8
METROPOLITAN NASHVILLE PUBLIC SCHOOLS
REQUEST FOR LEAVE OF ABSENCE
TO TEACH IN A CHARTER SCHOOL
The purpose of this type of leave is to allow the employee to retain accumulated leave and continuity of service. However, it should be noted
that the District can grant leaves only for specified periods of time. Employees may be granted leave to teach in a Charter School for up to one
year. Only tenured teachers qualify for this type of leave.
THIS COMPLETED FORM L-8 MUST BE SUBMITTED TO THE OFFICE OF EMPLOYEE BENEFITS AND APPROVED BEFORE THE LEAVE IS TAKEN.
Please answer all questions as completely as possible as inadequate information can delay processing.
SECTION I – (TO BE COMPLETED BY EMPLOYEE)
(Please Print)
Name _________________________________________ Employee # ______________Phone _________________
Address _______________________________________________________________________________________
(Street)
(City/ST)
(Zip)
School/Location ___________________________________________________ Title _________________________
Date Requesting to Begin Leave _________________________ Return Date _______________________
Charter School: _________________________________________________________________________________
Hire Date: _____________________________________________________________________________________
Employee Signature: ____________________________________________________Date ____________________
SECTION II (TO BE COMPLETED BY THE PRINCIPAL/DEPARTMENT SUPERVISOR)
I Acknowledge the Following Leave Request: From _______________To ____________
Comments: _____________________________________________________________________________________
Principal/Supervisor ___________________________________Title __________________________Date _________
Signature
SECTION III – (TO BE COMPLETED BY HUMAN CAPITAL)
APPROVAL STATUS:
( ) Leave is Approved
( ) Leave is NOT Approved
LEAVE DATES APPROVED From: ______/_______/_______ To: _______/_______/_______
Comments: _____________________________________________________________________________________
Approval Signature __________________________________________________ Date ________________________
EMPLOYEES MUST NOTIFY EMPLOYEE BENEFITS IN WRITING OF THEIR AVAILABILITY TO RETURN TO ACTIVE SERVICE
TWO WEEKS IN ADVANCE OF THEIR RETURN DATE
PLEASE RETURN FORM TO METROPOLITAN NASHVILLE PUBLIC SCHOOLS EMPLOYEE BENEFITS
2601 BRANSFORD AVE  NASHVILLE TN 37204  FAX 615/214-8665
QUESTIONS CALL 615/259-8410 or 259-8641
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