LAFOURCHE PARISH SCHOOL BOARD
LAFOURCHE PARISH SCHOOL BOARD Office of Transportation Employee Leave Request (Please Print) Name:
Employee’s Number:
Bus Driver
Bus Monitor
Date(s) of Absence:
A.M.
P.M.
A.M.
P.M.
A.M.
P.M.
A.M.
P.M.
A.M.
P.M.
Please indicate one of the following reasons for your absence: Sick Leave Emergency Leave (
Illness in Family *;
Death ** )
Name & Relationship: _____________________________________________________
Personal Leave Day(s) *** Jury Duty (Please attach subpoena)
Emergencies for sick leave purposes shall be defined as:
* Illness or accident in the immediate family of such nature as to involve the employee in an emergency. A maximum of two (2) days continuous leave shall be allowed the employee because of an illness or accident in the immediate family, and any leave thereafter shall be accounted for by a practicing physician’s statement. Immediate family includes spouse, child(ren), father, mother, or legal dependent under employee’s roof.
** Death in the immediate family which shall be construed to be the existence of an emergency for maximum of three (3) days, one of which shall include the day of the funeral; any additional days above the three days allowed shall not be considered emergency. Immediate family includes spouse, child(ren), father, mother, legal dependent under employee’s roof, father-in-law, mother-in-law, brother, sister, brother-in-law, sister-in-law; son-in-law, daughter-in-law, grandparents, grandchildren, or step relations.
*** 3 days – Any personal leave days taken beyond the three days allowed by board policy will be considered as unpaid leave days.
Employee Signature
Date
Transportation Approval
Date
Was a substitute available? Yes
No
(If yes, whom _____________________________________)
Employee’s Number:
Bus Driver
Bus Monitor
Date(s) of Absence:
A.M.
P.M.
A.M.
P.M.
A.M.
P.M.
A.M.
P.M.
A.M.
P.M.
Please indicate one of the following reasons for your absence: Sick Leave Emergency Leave (
Illness in Family *;
Death ** )
Name & Relationship: _____________________________________________________
Personal Leave Day(s) *** Jury Duty (Please attach subpoena)
Emergencies for sick leave purposes shall be defined as:
* Illness or accident in the immediate family of such nature as to involve the employee in an emergency. A maximum of two (2) days continuous leave shall be allowed the employee because of an illness or accident in the immediate family, and any leave thereafter shall be accounted for by a practicing physician’s statement. Immediate family includes spouse, child(ren), father, mother, or legal dependent under employee’s roof.
** Death in the immediate family which shall be construed to be the existence of an emergency for maximum of three (3) days, one of which shall include the day of the funeral; any additional days above the three days allowed shall not be considered emergency. Immediate family includes spouse, child(ren), father, mother, legal dependent under employee’s roof, father-in-law, mother-in-law, brother, sister, brother-in-law, sister-in-law; son-in-law, daughter-in-law, grandparents, grandchildren, or step relations.
*** 3 days – Any personal leave days taken beyond the three days allowed by board policy will be considered as unpaid leave days.
Employee Signature
Date
Transportation Approval
Date
Was a substitute available? Yes
No
(If yes, whom _____________________________________)
