Employee Name definition

Employee Name. Job Title: Course: Course Enrolment: Contract Number: Start Date: End Date: Number of Seminars: Duties Hours Details

Employee Name. Grade Level/ Assignment: School: Ashley Falls Carmel Del Mar Del Mar Heights Del Mar Hills Ocean Air Sage Canyon Sycamore Ridge Torrey Hills Certificated Status: Permanent Temporary Probationary 1st Year

Employee Name. Signature: List of Other Employees Involved: Date Occurred: Date of Step One Conference: Date Written Grievance Given to Supervisor: Statement of Grievance: (Use reverse side if necessary) Contract article(s) or practice(s) violated: Remedy Requested: STEP TWO (2) Supervisor Response Section Signed: Date: Supervisor Grievant: I accept the response □ Grievance is referred to Step Three: □ Signed: Date: Supervisor STEP THREE (3) Office of Human Resources Designee Date Received: Date of Hearing: Response: Signed: Date: Human Resources Official Grievant: I accept the response □ Grievance is referred to Arbitration: □ Signed: Signed: Grievant Union Representative Date: Date: 57 APPENDIX D—REIMBURSEMENT REQUEST FORM SEALS Growth on the Job Name Date Position Building The Professional Agreement (Article XXII, Section C) provides that tuition or other fees paid for classes, workshops, etc. relating to job performance and/or responsibilities will be reimbursed up to three hundred dollars ($300) annually provided that written approval is obtained from Human Resources prior to the start of the class or workshop and that proof of payment and evidence of successful completion are submitted to Human Resources. (Such things as mileage, lodging, and meals, etc. are not reimbursable.) If funds remain at the end of the year, approval may be granted for reimbursement for an additional class or workshop. Such requests must be made no later than June 1 for classes/workshops taken in the current school year. Reimbursement is requested for: (please check) □ Class/Course □ Workshop/Seminar □ Conference Describe the class, workshop, conference, etc. Include date(s), cost, etc. Additional information may be attached to this form if necessary. Note: Payment will be authorized upon receipt of proof of payment and evidence of satisfactory completion. Application forms and proof of payment and successful completion should be submitted to the personnel office. F O R O F F I C E U S E O N L Y □ Approved □ Denied Amountapproved Reason for Denial Reimbursement will be approved after June 1 if funds remain Date Signature APPENDIX E—BENEFITS FOR THE VOLUNTARY SHORT TERM DISABILITY COVERAGE ELIGIBILITY—All SEALS members are eligible to participate in this plan. EMPLOYER CONTRIBUTION—This is a voluntary benefit with no employer contribution. Participants will make 100% contribution for the benefit. PERCENT OF SALARY—66.67%. WEEKLY MAXIMUM—$500 per week. MINIMUM BENEFIT—$20.00 per week. ELIMINA...

Examples of Employee Name in a sentence

• Employee Name:   Employee Signature and Date: I, the supervisor, affirm that the employee meet all the noted criteria.

• Date: / / Signature/Payroll Department Date APPENDIX I SAN YSIDRO SCHOOL DISTRICT CATASTROPHIC EVENT/ ILLNESS LEAVE BANK REQUEST FOR WITHDRAWAL FORM (CERTIFICATED) Employee Name: Position: I hereby request to withdraw days of sick leave from the Catastrophic Event/Illness Leave Bank.

• Tahoma School District #409 Standards for Quality Professional Practice Addendum 11: ESA Evaluation Form Employee Name: Sch.

• Date: Employee’s copy - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Date: _ Employee Name: _ _ Hire Date: Supervisor Name: _ _ _ Check one: _ Shift Change: I wish to be considered for the next opening on the following shift: _ _ Schedule Change: I wish to be considered for the next opening with the following schedule: _ _ _ Employee Signature Supervisor Signature Check one: _ I accept the above requested shift or schedule.

• I will/did provide the following CARE (please specify) to my SERIOUSLY ILL FAMILY MEMBER (Name of Seriously ill family member) Who is my (check one): ❑ Spouse ❑ Parent ❑ Child under 18 ❑ Child 18 or over incapable of self care Print Employee Name Employee Signature Date CERTIFICATION BY HEALTH CARE PROVIDER I have read the DEFINITIONS on the reverse side and I certify that the individual named above as the SERIOUSLY ILL FAMILY MEMBER is my patient who suffers from a SERIOUS HEALTH CONDITION as defined.

More Definitions of Employee Name

Employee Name. Date: __/__/__ Employee Signature:_________________________ Company Authorized Officer name: _____________ Date: __/__/__ Signature:_________________________________

Employee Name. Date: Employee Sign:

Employee Name. (please print) Employee ID Number: (6 digit, network login ID Number) School or Dept Affiliation: (School/Dept) Employee Signature: Date:

Employee Name always means initials and surname.

Employee Name. Site: Date: Tag # Description Manufacturer Model Serial # Loan Date Return Date Employee Signature Date Principal/Designee Signature Date District Manager Signature Date Dept. Chair Signature (if needed) Date Upon return of the loaned equipment listed above, I have inspected the equipment and believe it to be free of any additional damage.

Employee Name. PART C: Essential Job Functions If provided, the information in Section I question #4 may be used to answer this question. If the employer fails to provide a statement of the employee’s essential functions or a job description, answer these questions based upon the employee’s own description of the essential job functions. An employee who must be absent from work to receive medical treatment(s), such as scheduled medical visits, for a serious health condition is considered to be not able to perform the essential job functions of the position during the absence for treatment(s).

Employee Name. SCHOOL: POSITION: DATE HIRED: I hereby report that I was convicted of, or plead guilty to nolo contendere to, the following violation of a criminal drug statute arising from workplace conduct. (Describe violation, when and where it happened): This conviction/disposition was entered in the following court at the date shown. COURT: DATE: TODAY’S DATE: I understand that within thirty (30) days of today’s date, the Southwick Tolland Regional School District must either discipline me, including the possibility of terminating me, or refer me for participation in an authorized drug abuse assistance or rehabilitation program. If referred, and accepted by me, I must satisfactorily take part in the program to continue m employment in the Regional School District. DRUG ABUSE ASSISTANCE OR DISCIPLINARY ACTION REHABILITATION PROGRAM SIGNATURE DATE APPENDIX E NURSE EVALUATION SOUTHWICK-TOLLAND-GRANVILLE REGIONAL SCHOOL DISTRICT SCHOOL NURSE PERFORMANCE EVALUATION Name: School: Date of Evaluation: This tool is based on the Standards of School Nursing Professional Performance, as developed by the National Association of School Nurses, and is a reflection of the Southwick-Tolland-Granville Regional School Districts School Nurse Job Description. Ratings are based on the nurse’s Professional Development Plan, evaluation by school principals and by direct observation of nurses by the Director of Health Services. Such observations may include: scheduled and unscheduled visits to health offices, attendance and participation during meetings and professional development days, and staff and student educational offerings given by nurses. Key: 3= Exceeds expectations 2 = Satisfactory 1= Needs improvement N/A = Not observed