Leave Requests Should Be Submitted at Least Five Days Prior to Absence

LEAVE REQUEST

(Leave Requests should be submitted at least five days prior to absence)

Section 1 Must be completed

Employee Name______Worksite/Campus______Subfnder #______

Home Address______City______State______Zip______

Reason for Leave (Select One):

¨Annual / ¨Funeral / ¨Job-Related Business / ¨Personal (Unpaid)
¨Awarded (Merit) Paid Personal / ¨Furlough Restoration / ¨Jury/Civic/Political / ¨Professional Development
¨CSEC or NEA Business / ¨In-District Activity / ¨Paid Personal / ¨Other
Notes:

Employee Signature______Date______Supervisor Signature ______Date______

Section 2 (Complete in addition to section 1 if any of the following apply…)

¨In-State Travel / ¨Substitute Required? / ¨Yes / ¨No
¨Out-of-State Travel / ¨Students Involved? / ¨Yes / ¨No

Reason for Leave/Trip (i.e. conference name) ______

Destination______No. of School/Work Days Involved______

Date leaving from Las Cruces______Estimated time______am or pm

Date returning to Las Cruces______Estimated time ______am or pm

Cost Estimates (Fill out only if expense to district is involved) To be completed by Control Agent

Estimated Amount / Cost Center/Object Code / PR/PO#/Sub. Authorization Code
Substitute / $
Per Diem / $
Registration Fee / $
Plane Fare / $
School Car Mileage / $
Other Describe / $
Other Describe / $
Other Describe / $
Total Estimate Cost / $

Employee Name______Date______

Approved by Supervisor/Principal______Date______

Control Agent______Date______

If requesting a school car, you must send School Vehicle Use Application, Form #76, to the Operations Annex Dept. If students are traveling out-of-state, a Request for Out-of-State Student Travel, Form IJOA-E3, must be sent separately to Associate Superintendent of Human Resources Development as per Policy IJOA & Regulation IJOA-RA “FIELD TRIPS & EXCURSIONS,” ensuring your proposal for this trip is included in the packet. Contact your school secretary for deadline information. NOTE: The Request for Out-of-State Student Travel along with your proposal must be submitted to Instruction Dept. at least four weeks in advance for approval from Board of Education.

Revised: July 2016