Ohr Form 400A PDF Details

Understanding the complexities of requesting leave as a certificated school-level employee within the Department of Education necessitates a thorough examination of the Ohr 400A form. Last revised on January 1, 2011, and evolving from previous forms including the 400, 400a, 400a.1, and 400F, this document serves as a critical tool for employees seeking various types of leave, including but not limited to family, military, funeral, personal sick, health, leave without pay (LWOP), personnel development, and vacation leave. Applicants are required to provide essential employee information, details of the leave request, and, depending on the nature of the leave, additional documentation such as a physician's statement for health-related absences or military orders for military leave. The process also entails the necessity of approval from direct supervisors or, in some cases, higher authorization from Principal/Immediate Supervisor and PRO/CAS for certain types of leave. This form not only outlines the procedure for requesting leave but also stipulates the distribution of the completed forms, ensuring a comprehensive approach to managing leave requests effectively and efficiently. As such, for educators and administrative staff navigating their rights and responsibilities regarding leave, understanding the components and stipulations of the Ohr 400A form becomes a vital aspect of their professional lives.

Form NameOhr Form 400A
Form Length1 pages
Fillable fields0
Avg. time to fill out15 sec
Other namestseas hawaii, hawaii doe leave of absence form, hawaii doe leave of absence, maritime leave request form

Form Preview Example




DOE OHR 300-001

Last Revised: 01/01/2011

Former DOE Form(s): 400, 400a, 400a.1, 400F


Ofice of Human Resources Records and Transactions Section, Certificated

P.O. Box 2360 Honolulu, HI 96804





Name: _____________________________________________________________

Last 4 digits of SSN: _____________________





Address: _________________________________________

City: _____________________ State: _______ Zip: ______________

Tel#: ________________________

Position: _________________________

School/Office: ______________________________

School or Sub-Division Code: _ _ _

Leave Code: _ _ _

Bargaining Unit Code: _ _

II. LEAVE REQUEST (Complete appropriate subsection below.)

Family 1


Military 4


Political 5


Other: __________________




Funeral 2




Sick 3











Health, LWOP 3


Personnel Development





1Complete and attach Federal Form WH-380F or WH-380E(Sde).

3Complete Licensed Physician's Statement by completing Section IV at bottom of this form for Health leave or if Sick leave for more than five (5) consecutive days or submit a signed doctor's note verifying current health condition. Approval for sick leave is subject to the availability of accumulated sick leave.

2Provide relationship to deceased and address if out of state in #2 below.

4Attach a copy of your military orders with this form (copy) to OHR, Records and Transactions Section, Certificated.

5Attach a separate letter justifying political appointment.

I hereby request the following type of leave:



Leave with Pay



Leave without Pay for the calendar period below:

From: _______________________

To: _______________________






# of working days

1. Is this an extended leave?












2.Provide any additional explanation for leave request (attach a separate sheet if necessary):


Employee Signature: _______________________________________________________ Date: _______________________



For sick, vacation, and personal leave, Principal/Immediate Supervisor approval required.

For family, military, personnel development, and political leave,both Principal/Immediate Supervisor and PRO/CAS approval required.






Not Approved Supervisor Signature: __________________________________________

Date: _________________






Not Approved PRO/CAS Signature: ________________________________________

Date: _______________




(To be completed ONLY for HEALTH LEAVE or if SICK LEAVE is for more than five (5) consecutive work days)

I certify that _________________________________ is under my care for health reasons and is not physically able to perform

his/her normal work duties from _______________________ to ______________________.


Licensed Physician Signature: ________________________________________

Date: _______________________



Name of Licensed Physician (Print): __________________________________

Type of Practice: ___________________________

Address: __________________________________________________________

Tel#: ____________________________________

Distribution: Leave with Pay (Teachers): 1. Original - School; 2. Copy 1 - Employee; 3. Copy 2 - PRO (if leave exceeds one month) / Leave With Pay (EOs): 1.

Original - School; 2. Copy 1 - Employee / Leave Without Pay and Military Leave With Pay: 1. Original - OHR, Records and Transactions Section, Certificated; 2. Copy 1 - Employee; 3. Copy 2 - School; 4. Copy 3 - PRO; 5. Copy 4 - Payroll Office, Leave Accounting Section

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How to Edit Ohr Form 400A Online for Free

It is really straightforward to fill out the department of education hawaii family leave spaces. Our software makes it almost effortless to work with almost any PDF file. Down below are the primary four steps you need to take:

Step 1: Hit the orange button "Get Form Here" on the following webpage.

Step 2: Now you are on the file editing page. You can edit, add information, highlight certain words or phrases, place crosses or checks, and include images.

The next few sections are what you will have to create to receive the finished PDF document.

part 1 to completing hawaii doe school use fillable form

You should submit your information inside the segment Provide any additional, Employee Signature Date, MMDDYYYY, III LEAVE APPROVAL, For sick vacation and personal, Approved, Not Approved, PrincipalImmediate Supervisor, Approved, Date, MMDDYYYY, Not Approved PROCAS Signature, Date, MMDDYYYY, and IV LICENSED PHYSICIANS STATEMENT.

Completing hawaii doe school use fillable form stage 2

Step 3: As soon as you select the Done button, the final document is easily exportable to each of your gadgets. Alternatively, you might deliver it by using mail.

Step 4: To prevent yourself from potential upcoming complications, it is important to have no less than two duplicates of each separate file.

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