ࡱ> y bjbj {{>>D<\,$ :#r&&&&&W`/=)Bo,0\w$^.$$H S.\&&&&$> ^: ( LEAVE REQUEST ( VACATION CASH OUT REQUESTLast Name:First Name:Employee No.Job Title:Work Location:Phone #s:Leave Request ( Vacation( Personal Leave( Critical Illness*( Bereavement*( Sick Leave( Child Care( Sick Leave (Family)*( Other (Specify):*Relationship: SAP Leave Code (see reverse):FMLA? (see reverse)( Yes ( No Leave Date(s) Total # hours:Vacation Cash Out Request( Request to cash out vacation days in accordance with terms of my employment contract. Please complete the following:1. Number of vacations days accrued to date:2. Number of vacations days requesting to cash out:3. Number of vacations days remaining after cash out:Comments:Employee Signature:Date: DATE \@ "MMMM d, yyyy" September 26, 2012( Approved ( Not ApprovedSupervisor SignatureDateDisapproval Reason:Date Posted in SAP:Initials:Attach copy of SAP screen print of approved timeS:\ERForms\Leave Request Form.doc SAP Leave Codes Quick reference: Vacation 2000 Sick Leave 2005 Personal Leave - 2015 Administrative Leave2070Adult Basic Education1100Behind Wheel Training1130Bereavement Family2030Bereavement Other3005Bus Aide1210Child Care1220Clerical Extended Time1230Community Education1080Critical Leave - Family3015Critical Leave Other3010Critical Leave Teacher3020Detail Overtime1160Direct Instruction1020Drivers Education1090EA Extended Time1240Extended Contract1030Health Services1200Holiday Pay1035Jury Duty2025Leadership Hours1070Lost Prep Hours1050Military Leave, Paid2080Military Leave, Unpaid2085MPLS Kids1170On-Call Pay1250OT Pay 1.5X1140OT Pay Double time 2X1150Out for Union Reasons2045Pay when Subpoenaed2035Personal Leave, Paid2015Personal Leave, Unpaid2020Premium Pay1180Regular Hours1000Religious Observance2055Reserve Teacher1010Sick Leave Pool3000Sick Leave, Paid2005Sick Leave, Unpaid2010Special Education1190Sp Ed Assess. & IEP Plan0902Sp Ed Child and Pupil ID0900Sp Ed Due Process0904Sp Ed Misc. Functions0906Sp Ed Other Instructional0905Sp Ed Pre-Ref Activity0901Sp Ed Support Services0903Staff Development1060Stipend Hours1040Summer School1120Suspension, Paid2060Suspension, Unpaid2065Teacher Hourly Rate1110Vacation2000Work Comp Student Assault2075 Family Medical Leave Act (FMLA) InformationThe information provided in this section is not intended to be a complete and full description of the Family Medical Leave Act. It is intended as general information, only. For more information regarding leaves of absence and FMLA leave in particular, please contact the HR Staffing Specialist for your area. MPS 4016 - GENERAL STATEMENT OF POLICY: It is the policy of the Minneapolis Public Schools to provide up to twelve weeks of family and medical leave per calendar year to eligible employees in compliance with the Family and Medical Leave Act. Employees may use paid sick leave for this purpose, at the option of the employee, when usage of the sick leave is in accordance with the provisions of any applicable collective bargaining agreement. The employee may use accrued vacation or personal leave at the employee's option, when usage of the vacation or personal leave is in accordance with the provisions of any applicable collective bargaining agreement. Otherwise, such leave is unpaid leave. All leave requested under this policy will conform to guidelines established by the Human Resources Department. Eligibility: Employees must have been employed with the District for at least one year and worked at least 1250 hours to be eligible for FMLA leave. 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