Change in employment status includes return to work, discontinuance of work, increase or decrease of regular hours of work and increase or reduction of wages.

Use this form to claim out-of-pocket expenses related to your injury or illness.

Complete this form to claim disability benefits only if your Workers’ Compensation claim has been rejected.

Here is the form for an attending doctor to obtain medical authorization:

Complete this form and file it with your school payroll secretary within 10 days.

All pedagogues and paraprofessionals may use this form to donate sick time to a colleague. The recipient receives one day for every two days donated. Sick leave transfer rules are on page 2 of the form.

All pedagogical personnel may apply for a medical leave of absence without pay only when they have exhausted all of their Cumulative Absence Reserve (CAR) days. This application must be completed, signed and submitted to HR Connect for approval...

Upon an employee’s return from a leave of absence without pay, the payroll secretary must submit an OP 255 form to the Bureau of Salary Differentials and Status.

Upon resignation, termination or retirement, pedagogues are entitled to receive half of their sick leave balance (up to 100 days).

For pedagogues and administrative staff. You must provide acceptable certification by a physician or other health care provider for your own serious health condition or the serious health condition of a covered family member within fifteen (15)...

Must be filed along with a FMLA request.

Authorization for voluntary deduction.

This form must be completed and submitted to the per session supervisor prior to commencement of employment in a per session activity. Waivers for per session activities that will exceed 400 hours must be submitted electronically through the DOE's...

This form is used to transfer accrued per-session sick leave to the employee's regular cumulative absence reserve.

This form is for payroll secretaries.

Use this form to file a claim if your eyeglasses were damaged in an assault.

If an accommodation request is denied or cannot be provided through informal means, the employee may apply for a formal accommodation by submitting the Accommodation Request Form on page 2. Medical documentation to support the request must be...

See Chancellor's Regulation A-443 for information on student disciplinary procedures and student removal.

This form is used to request a correction or duplicate W-2 for the current tax year and/or the three previous years. Requests for earlier W-2s are handled by the Office of Payroll Administration or the Office of Employment Records Research.

After you have read the dental claim form instructions (below) you are ready to fill out the dental claim form as needed.

This form is used by all pedagogues to apply for medical certification for absence up to 20 consecutive school days, for requests to borrow sick days, for excuse of absence due to children’s diseases, and for injury in the line of duty claims. Rules...

Use the forms in this package to report occupational exposure incidents. Exposure incident means a specific eye, mouth, other mucous membrane, non-intact skin or parenteral contact with blood or other potentially infectious materials that results...

Moving forward, all informal providers will receive the standard 2007 market rate without having to apply. In order to receive the 2007 rate retroactively, informal providers must apply for it and attest that their cost of care has increased. Please...

Registered family and licensed group providers whose rates listed on file with ACS are not already higher than the 2007 market rate should use this form to apply to receive the new market rate moving forward and retroactively.

Informal providers should use this form to record any training sessions they attend. Informal providers who complete 10 or more hours of approved training in at least two different approved topics may be eligible to receive a higher, "enhanced"...

If you have performed SESIS-related activities at home because you have been directed to do so, you can file a grievance within thirty (30) school days from the time you were instructed to perform the activity.

Have you had to work beyond your regularly scheduled work day within the past 30 school days? If so, please provide us with specific details of what happened, when it happened, what if anything you did to try to rectify the problem, if you were...