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405.3P - Jury Duty Pre-Approval

405.3P - Jury Duty Pre-Approval

Adopted: December 1977
Revised: August 2012


Download 405.3P - Jury Duty Pre-Approval


The employee must complete this form and sent it to the Payroll Department within three days of receiving a jury duty notice.


Note:  When an employee returns to work after jury duty is completed, he or she must submit an employee absence report with a certificate from the county stating the number of days and dates served.  If applicable, a deduction will be made on the next paycheck.

          I hereby give notice of my absence from work to participate in jury duty


          service.  Attached is a copy of the request I received from                                  

                                                                                                      (county court)

          for jury duty beginning on                                         .

                                                     (month)       (date)  (year)


Name of employee (please print)                                                                                  


Employee classification: 


          _____ Administrator                                            _____ Food Service

          _____ Building Chief                                                   Non-licensed Specialist

          _____ Bus Driver/Chaperone/Crossing Guard     _____ Special Staff

          _____ Clerical                                                     _____ Teacher/Nurse

          _____ Custodial                                                  _____ Vehicle Technician



Signature of employee                                                         Date                               


Signature of principal or supervisor                                     Date                               






Notification received                                    




                                                                             Payroll Department