Accident Form

Citizens Accident Report Form

If an injury occurs on the job fill out this form, have your supervisor sign it, make two copies (one copy goes to the employee, one copy to supervisor, and original to Human Resources). For guidelines and clinic information see the procedure page of our website.


Americans with Disability Act (ADA) Request Form

Employee's with a disability that would like to request reasonable accommodations for their job responsibilities because of their disability can complete this form and return it to HR.

Address Change

Address / Phone Number Changes

Employees can change their Address/Phone/Emergency Contact information on the Employee Portal link  , click on "Change Personal Info" or "Change Emergency Contacts", update the information and click save. This will automatically change the information in the payroll and HR system.

Card Access Change

HR issues new cards, changes access levels to current cards and replaces lost, stolen, or damaged cards. Problems with cards not working need to be made by submitting a work order or contacting the Maintenance Department at (586)723-2250.

If you have lost, damaged, or had your card stolen please contact Michael Mann immediately by phone (586) 723-2095 or email so that the card can be deactivated. If an employee fails to report a lost card it could compromise the integrity of the security system and the employee may be subject to disciplinary action for failure to report the loss. The cost for replacements cards are $10.00 and can be paid by cash, check or payroll deduction. The replacement card will be issued upon receipt of their payment.

Retirements/Resignations - If you resign or retiree please send your to the HR department for deactivation. If a retired/resigned employee fails to return their card to HR a $10.00 replacement fee will be deducted from their last paycheck.

To request a change to be made or to add access to your card please complete a card access change request form, have your principal/supervisor approve and send to HR.

District Provided Professional Development Tracking Form

This form is used for teacher to track and use district provided professional development for renewing their Professional and/or Occupational Certification's only.


Family Medical Leave

Chippewa Valley Schools Family Medical Leave Policy and Procedures

Certification of Health Care Provider form for Employee's Serious Health Condition
This form is to be completed if you are requesting an FMLA leave for your own serious health condition.

Certification of Health Care Provider form for Family Member's Serious Health Condition
This form is to be completed if you are requesting an FMLA leave if needed to care for a covered family member with a serious health condition.

Certification for Serious Injury or Illness of Covered Service member--for military family leave
This form is to be completed if you are requesting an FMLA leave due to a serious injury or illness of a covered service member.

Certification of Qualifying Exigency for Military Family Leave
This form is to be completed if you are requesting an FMLA leave due to a qualifying exigency.

 Certification for Serious Injury or Illness of a Veteran for Military Caregiver Leave
This form is to be completed if you are requesting an FMLA leave if needed to care for a Veteran Military member.

Teacher Growth Goal Information

Growth Goal Information

May this serve as a guide to teacher's as to how growth goals are rated and a sample form they are to use to submit their goals in OASYS for the year.  Growth goals are due by September 30th every school year.


Harassment/Discrimination Complaint Form

Every staff member must report any situation that they believe to be improper harassment/discrimination towards staff or students. Reports may be made by filling out the form at the above link. Complaint forms should be submitted to the Assistant Superintendent of Human Resources or if it is regarding a disability discrimination then the form should be submitted to the Director of Special Education.

Review Personnel File

Request to Review Personnel File Form

For those employee's who wish to review their personnel file please complete this form and forward it to the Human Resource Department. Once we are in receipt of this form we will contact you to schedule an appointment for you to come in and review your file.

Transfer Form

This form is to be used by Chippewa Valley Employee's only (except clerical staff), to apply for posted vacancies.  Teacher will also use this form to inform HR of their interest in transferring and being placed on the teacher transfer list.

Tuition Reimbursement

Secretarial/Clerical Tuition Reimbursement Form

Administrator Tuition Reimbursement Form

Tuition Reimbursement forms should be completed prior to taking a course/seminar. At the time of initial approval please attach a copy of your registration for the course/seminar and a copy of your receipt showing you have paid for the course/seminar.

Once you have completed the course/seminar please submit to HR a copy of your certificate of completion or transcript with final grade. Once received reimbursement will be processed.