Tatum ISD Bereavement Application

Tatum ISD Bereavement Leave Request Form

Employees are eligible to receive 5 days of paid bereavement leave, per fiscal year upon the death of an immediate family member as outlined in DEC(LOCAL). Documentation will be required to verify the status of an immediate family as defined in board policy. For purposes of the Family and Medical Leave Act (FMLA), the definitions of spouse, parent, son or daughter, and next of kin are found in DECA(LEGAL).

1. Inform your campus principal, immediate supervisor, and the Human Resources Department within 5 days after the death of an immediate family member.

2. Complete the Bereavement Leave Request Form, provide supporting documentation, and submit these documents to the Human Resources Department within 15 days following the death of an immediate family member for approval. Examples of supporting documentation include a funeral notice, obituary, or death certificate.

3. Bereavement leave must be used within 60 days of the death of an immediate family member. The leave must occur within the same fiscal year as the request and does not need to be consecutive. The Human Resources Department may review and consider extenuating circumstances.
Name*

First NameLast Name
Employee Number*
Email*
Campus or Department*

Tatum Primary SchoolTatum Elementary SchoolTatum Middle SchoolTatum High SchoolCafeteriaCustodialMaintenanceTransportationTechnologyRusk County Co-OpAdministration
Deceased person is my :*

SpouseSon or daughter, including a biological, adopted, or foster child, a son- or daughter-in-law, a stepchild, a legal ward, or a child for whom the employee stands in loco parentisParent, stepparent, parent-in-law, or other individual who stands in loco parentis to the employeeSibling, stepsibling, and sibling-in-lawGrandparent and grandchildAny person residing in the employee's household at the time of illness or death
Relationship to employee if not clearly stated on document provided
Date(s) of Absences:*
Please return the required documentation to the Tatum ISD Human Resources Department by:

Fax: 1-903-705-4444

Email: youngm@tatumisd.org

In-person or by mail: 510 Crystal Farms Rd., Tatum TX 75691
The option to upload supporting documentation is available here.

Cancelof
During the approval review, the following will be taken into consideration; the date of the death, the dates of visitation, the dates of memorial/funeral service, the date of the home-going celebration, and the date of the internment. In addition, the location of these functions and whether out-of-town/out-of-state travel time is needed shall be considered for approval to attend these functions.

Any days in excess of days approved for bereavement leave shall require the usage of the employee's personal leave, i.e., state personal/sick and local leave, vacation days, or comp time accrued. If an employee has exhausted all leave, the employee's pay shall be docked for his or her absences.
Employee Signature*

Clear
Date*

MonthDayYear
Date

Submit
Should be Empty:

HUMAN RESOURCES DEPARTMENT ONLY