SAMPLE LETTERS

The following are sample letters that you can submit to the Human
Resource Office when requesting a maternity leave of absence using
sick leave or extending a maternity leave of absence using sick leave.
SAMPLE LETTER #1
Name & Address Date
XXXXXXXXXXXX
Director of Human Resources
Lorain City Schools
2350 Pole Ave.
Lorain, OH 44052
Dear XXXXXXXXX,
I am expecting a child and my projected delivery date is 06 November 2013. I anticipate 24
September 2013 as my last day of work. I plan on using maternity leave throughout my absence
until 22 December 2013.
Enclosed is my doctors statement.
I will await written verification from your office, which approves my intent.

Sincerely,
C: LEA President
File

SAMPLE LETTER #2
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XXXXXXXXXX
Director of Human Resources
Lorain City Schools
2350 Pole Ave.
Lorain, OH 44052
Dear XXXXXXXXXX,
I wish to extend my sick leave following the birth of my daughter. I had requested this
leave to end on XXXXXXXXXXX. However due to complications, I will be unable to return
to my XXXXXXX position at XXXXXXXXX School until XXXXXX. I am enclosing a letter
from my childs physician verifying the necessity of my remaining home.
Thank you for your assistance in this extension of my use of sick leave. If you have
further questions, please call.
Sincerely,
C: LEA President
File


SAMPLE #3
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XXXXXXXXXX
Director of Human Resources
Lorain City Schools
2350 Pole Ave.
Lorain, OH 44052
Dear XXXXXXXXXX,
This letter is written to inform you that I will be on sick leave beginning
XXXXXXXXXXXXXXXX. My expected due date is on XXXXXXXXXXXXX. Depending upon
the nature of my delivery, I am unsure of my intentions after the baby is born. As soon
as I am aware of the situation, I will let you know.
Enclosed, please find a medical excuse from my doctor.
Sincerely,
C: LEA President
File


SAMPLE LETTER #4
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XXXXXXXXXX
Director of Human Resources
Lorain City Schools
2350 Pole Ave.
Lorain, OH 44052
XXXXXXXXXX,
Please be advised that I will begin using sick leave because of pregnancy on about
XXXXXXXXXXXXXXX. At the present time I plan to use sick leave until my doctor
releases me to return to my duties. Due to the high-risk nature of my pregnancy, my
doctor predicts my return to be around XXXXXXXXXXXX (see attached note). My
teaching assignment for the XXXXXXXX school year is XXX grade at XXXXXXXXXX
School.
I will call the substitute service as soon as I know the exact date that I will begin to use
sick leave. If possible I would like to have my substitute overlap for a couple of days so
that I can inform him/her about my class, their progress so far this school year, and the
materials which should be covered during my absence.
Thank you for your assistance in this matter.
Sincerely,
C: LEA President
File

SAMPLE LETTER #5
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Dr. E, Branham
Director of Human Resources
Lorain City Schools
2350 Pole Ave.
Lorain, OH 544052
Dear Dr. Branham,
On or about XXXXXXXX I will be using sick leave for a pregnancy disability. I will return
from using my sick leave when I am released by my doctor from his/her care.
Sincerely,
C: LEA President
File