Humble Independent School District - Leave of Absence Application
Leave of Absence Application
Organization:
Humble Independent School District
Assigned To:
Public User
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Please answer the questions below.
If you will be absent more than 10 consecutive work days, you must file this Leave Application with the HR Dept prior to the start of the leave.
TYPE OF LEAVE:
Temporary Disability Leave (part-time OR worked for Humble ISD less than 1 yr)
Family/Medical Leave (full-time AND worked for Humble ISD longer than 1 yr)
Assault Leave (injured on school property/at event. Contact HR)
Intermittent FMLA (must be eligible for FMLA + have one recurrent medical issue)
TYPE OF LEAVE: required
Last Name
Last Name required
First Name
First Name required
Location
+ Other...
ACADEMICS
Accountability/Assessment
ACCOUNTING & REPORTING
ACCOUNTS PAYABLE
ADVANCED ACADEMICS
Assistant Superintendent Schools
ASST SUPTS SCHOOLS
ATASCOCITA HIGH SCHOOL
ATASCOCITA MIDDLE SCHOOL
ATASCOCITA SPRINGS ELEMENTARY
ATHLETICS
AUTUMN CREEK ELEMENTARY SCHOOL
AUTUMN RIDGE MIDDLE SCHOOL
AVID PROGRAM
BEAR BRANCH ELEMENTARY
BENEFITS
BOARD
BUDGET DEPT
CAMBRIDGE SCHOOL
CAREER & TECHNOLOGY - DEPT
Career & Technology Dept
CATE - Career & Technology Education Center
Centennial Elementary
CENTENNIAL ELEMENTARY SCHOOL
Central Services/Distribution Center
CENTRAL SRVCS/DISTRB CENTER
CHILD NUTRITION
COMMUNITY DEVELOPMENT
COMPUTER SERVICES
Counseling and Behavioral Services
CREEKWOOD MIDDLE SCHOOL
CUSTODIAL
DAEP - Disciplinary Alternative Education Program
DATA QUALITY
DEERWOOD ELEMENTARY
DEPUTY SUPERINTENDENT
DISCIPLINE PROGRAM
DOCUMENTS / RECORDS
EAGLE SPRINGS ELEMENTARY
Early Childhood Center
EARLY LEARNING SERVICES
ELM GROVE ELEMENTARY
ESL / BILINGUAL
FALL CREEK ELEMENTARY
FIN SVCS - ASST. SUPT.
FIN SVCS BUSINESS SYSTEMS
FINANCE DEPARTMENT
Financial Services Business Systems
FINE ARTS
FOSTER ELEMENTARY
GREENTREE ELEMENTARY
GROUNDS
GROVES ELEMENTARY
HEALTH SERVICES
HIDDEN HOLLOW ELEMENTARY
HUMAN RESOURCES
HUMBLE ELEMENTARY
HUMBLE HIGH SCHOOL
Humble ISD
HUMBLE MIDDLE SCHOOL
Instructional Support Building
INTERNAL AUDIT
JACK FIELDS ELEMENTARY
KINGWOOD HIGH SCHOOL
KINGWOOD MIDDLE SCHOOL
KINGWOOD PARK HIGH SCHOOL
Lake Houston Middle School
LAKELAND ELEMENTARY
LAKESHORE ELEMENTARY
LEGAL
MAINTENANCE
MAPLEBROOK ELEMENTARY
MISCELLANEOUS ADMIN
NORTH BELT PRE-K CENTER
NORTH BEND ELEMENTARY
OAK FOREST ELEMENTARY
OAKS ELEMENTARY
OPERATIONAL SUPPORT SERVICES
PACE PROGRAM
PARK LAKES ELEMENTARY
Payroll
PAYROLL DEPT
PINE FOREST ELEMENTARY
PRINT SHOP
PROFESSIONAL DEVELOPMENT
Professional Learning
Public Communications
PUBLIC INFORMATION
PURCHASING DEPARTMENT
RIDGE CREEK ELEMENTARY
RISK MANAGEMENT
RIVER PINES ELEMENTARY
RIVERWOOD MIDDLE SCHOOL
ROSS STERLING MIDDLE SCHOOL
SAFETY
SCONZO EARLY COLLEGE HS
SECURITY
SHADOW FOREST ELEMENTARY
SPEC EDUC INSTR SUPPORT
SPEC EDUC ITINERANT
Special Education Instructional Support
Special Education Itinerant
STATE AND FEDERAL PROGRAMS
STUDENT SUPPORT SERVICES
SUMMER CREEK HIGH SCHOOL
SUMMER SCHOOL - ELEMENTARY
SUMMER SCHOOL - SPECIAL EDUCATION
SUMMER SCHOOL SECONDARY
SUMMERWOOD ELEMENTARY
SUPERINTENDENT'S OFFICE
SUPERINTENDENT`S OFFICE
SUPPORT SERVICES
TAX OFFICE
TIMBERS ELEMENTARY
TIMBERWOOD MIDDLE SCHOOL
TRANSPORTATION
WEST LAKE MIDDLE SCHOOL
WHISPERING PINES ELEMENTARY
WILLOW CREEK ELEMENTARY
WOODCREEK MIDDLE SCHOOL
WOODLAND HILLS ELEMENTARY
Campus or Job Location required
Home Address
Home Address required
City
City required
State
TX
Zip
zip required
Home Phone
Cell Phone
Personal Email
Personal Email required
Month/Yr hired by Humble ISD
Hired required
Work Schedule
Full-Time
Part-Time
Schedule required
REASON FOR LEAVE:
Birth of your child, or placement of a child with you for adoption or foster care
A health condition that makes you unable to perform the essential functions of your job
A serious health condition affecting a family member for whom you must provide care
REASON FOR LEAVE: required
If caring for a family member:
Spouse
Child
Parent
Explain the medical situation:
Characters Available:
ANTICIPATED DATES OF LEAVE:
Last day of work:
Expected return date:
Note: Medical certification from a healthcare provider must accompany your leave request. Use the LINK below to send the medical certification by uploading it OR ask your doctor to fax it to HR. YaWytrai Mukes, Leave Coordinator Phone: 281-641-8159 // Fax: 281-641-1057
Medical Certification Upload
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I understand that I will be cease being paid unless I have enough paid leave time accrued to cover all or most of my anticipated leave. I further understand that, if eligible, FMLA will run concurrently with Temp Disability, Workers Comp, and Assault leave. I further understand that leave ends either at 90 OR 180 calendar days. By submitting this form, I agree to the conditions of the Leave of Absence and that I will comply with the district's (campus and HR) procedures during the leave.
Please type your name and CLICK the BUTTON to sign digitally. Then click the Submit button.
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By typing in your name (your “eSignature”), you accept and consent to be legally bound by this document’s statements, terms and conditions as if this document was signed by you in writing with pen on paper. You agree that no third party or other means of verification is necessary to validate your eSignature and that the lack of such third party or other means of verification will not in any way affect the enforceability of this document.
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History
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Sent To: Public User, On:
12/28/2025 2:53:37 AM Central Standard Time