Use of Leave

	Use this form to select the order in which earned leave will be taken during your absence. You may also decide on the number of days per category to be charged to your leave balances.

1.	Full Legal Name*
	Last   First   MI Name

2.	Employee ID Number*

3.	Position:*

4.	Work Location:*
	--Please Select--ADVANCED ACADEMICSALEXANDER MIDDLE SCHOOLALTERNATIVE LEARNING CENTERASST SUPT ELEMENTARY EDASST SUPT INTERMEDIATEASST SUPT SUPPORT SERVICESATHLETICSBARBARA COCKRELL ELEMENTARYBERRY MILLER JR HIGHBUSINESS OFFICECAREER AND TECHNOLOGY EDCARLESTON ELEMENTARYCENTRAL ADMINISTRATIONCHALLENGER ELEMENTARYCOMMUNICATIONSCURRICULUMDAWSON HIGH SCHOOLDEPUTY SUPERINTENDENTFACILITIESFINE ARTS DEPARTMENTHARRIS ELEMENTARYHUMAN RESOURCE SERVICESJAMISON MIDDLE SCHOOLLAWHON ELEMENTARYMAGNOLIA ELEMENTARYMAINTENANCEOUTREACH/ATTENDANCE OFFICEPACE CENTERPEARLAND HIGH SCHOOLPEARLAND JR HIGH EASTPEARLAND JR HIGH SOUTHPEARLAND JR HIGH WESTROGERS MIDDLE SCHOOLRUSTIC OAK ELEMENTARYSABLATURA MIDDLE SCHOOLSHADYCREST ELEMENTARYSILVERCREST ELEMENTARYSILVERLAKE ELEMENTARYSPECIAL PROGRAMSTECHNOLOGY DEPARTMENTTRANSPORTATIONTURNER COLLEGE & CAREER HS

5.	Type of leave requested:*
	--Please Select--Family Medical Leave (FML)Temporary Disability Leave (TDL)Family Medical Leave/Temporary Disability Leave (FML/TDL)Workers Compensation (WC)

6.	Select the order in which you would like to use your leave during your absence and if you choose, fill in the number of days per category. Failure to designate the order will result in your leave being charged as follows: 1.State Sick Leave; 2. State Personal Leave; 3.Local Leave; 4. Vacation/Non-Duty; 5. Compensatory Time.
	Select Leave Type   Number of Days First Choice   --Please Select--State Sick LeaveState Personal LeaveLocal LeaveVacation/Non-Duty DaysCompensatory Time   Second Choice   --Please Select--State Sick LeaveState Personal LeaveLocal LeaveVacation/Non-Duty DaysCompensatory Time   Third Choice   --Please Select--State Sick LeaveState Personal LeaveLocal LeaveVacation/Non-Duty DaysCompensatory Time   Fourth Choice   --Please Select--State Sick LeaveState Personal LeaveLocal LeaveVacation/Non-Duty DaysCompensatory Time   Fifth Choice   --Please Select--State Sick LeaveState Personal LeaveLocal LeaveVacation/Non-Duty DaysCompensatory Time

7.	I have read and understand the use of leave information.*
	--Please Select--Yes No

	Click Done below to submit your information.