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Emergency Paid Sick Leave under FFCRA Request
Please complete the form below if you are not approved/or unable to work remotely. FFCRA allows for employees to take up to 10 consecutive workdays due to CoVID-19. FFCRA can be used only ONCE and if you are exposed or tested positive again for CoVID-19 your sick days will be used. For additional information visit https://www.dol.gov/agencies/whd/pandemic/ffcra-employer-paid-leave
Have you file for FFCRA in the past?
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Yes
No
Name
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Last Name
First Name
Employee ID
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Email
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example@example.com
Phone Number
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Please enter a valid phone number.
Position/Title
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Campus/Department
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Please Select
Albright Middle School
Alexander Elementary School
Alief Early College High School
Alief International Academy
Alief Learning Center
Alief Middle School
Athletic Dept.
Best Elementary School
Boone Elementary School
Budewig Intermediate School
Bush Elementary School
Business
Center for Advanced Careers
Central Distribution
Central Special Education Dept
Chambers Elementary School
Chancellor Elementary School
Collins Elementary School
Crossroads
Cummings Elementary School
Curriculum & Instruction
Elsik High School
Elsik Ninth Grade Center
Family & Community Engagement
Hastings High School
Hastings Ninth Grade Center
Hearne Elementary School
Health Services
Heflin Elementary School
Hicks Elementary School
Holmquist Elementary School
Holub Middle School
Horn Elementary School
Human Resources
Kennedy Elementary School
Kerr High School
Killough Middle School
Klentzman Intermediate School
Landis Elementary School
Liestman Elementary School
Mahanay Elementary School
Maintenance Dept.
Management Information Systems
Martin Elementary School
Mata Intermediate School
Miller Intermediate School
Nutrition Dept.
O'Donnell Middle School
Olle Middle School
Outley Elementary School
Owens Intermediate School
Payroll Dept
Petrosky Elementary School
Police
Printing Services
Printing Services
Public Relations
Purchasing
Rees Elementary School
Smith Elementary School
Sneed Elementary School
SOAR/LINC/NHS
Tax Office
Taylor High School
Technology Services
Telecommunications
Transportation
Warehouse
Youens Elementary School
Youngblood Intermediate School
Principal/Supervisor
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Start Date of FFCRA Leave
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-
Month
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Day
Year
Date
Reason for FFCRA
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I have been required to quarantine due to concerns related to COVID-19.
I am caring for a child whose school or place of care is closed due to COVID-19 related reasons (temporary school closure and/or school exposure), and job cannot be performed remotely/virtually.
FFCRA Proof
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proof of school closure or exposure notice, doctor's note, CoVID results, etc.
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