{"id":3151,"date":"2017-03-13T10:00:02","date_gmt":"2017-03-13T17:00:02","guid":{"rendered":"http:\/\/www.breining.edu\/?page_id=3151"},"modified":"2017-03-13T12:27:19","modified_gmt":"2017-03-13T19:27:19","slug":"dui-program-leave-of-absence-loa-request","status":"publish","type":"page","link":"https:\/\/www.breining.edu\/index.php\/programsservices\/dui-schools\/dui-program-leave-of-absence-loa-request\/","title":{"rendered":"DUI Program &#8211; Leave of Absence (LOA) Request"},"content":{"rendered":"<p class=\"Body\">You may submit this form to request a Leave of Absence (LOA) for the following reasons:<\/p>\n<ul>\n<li class=\"Body\">Travel for work<\/li>\n<li class=\"Body\">Military duties<\/li>\n<li class=\"Body\">Illness or family illness<\/li>\n<li class=\"Body\">Incarceration including home arrest (the $25.00 fee is waived for incarceration LOAs)<\/li>\n<li class=\"Body\">Extreme personal hardship or family emergency<\/li>\n<\/ul>\n<p class=\"Body\">You must submit the request for the LOA at least 24 hours in advance of the leave. You must submit documentation proving the reason for the request.<\/p>\n<p class=\"Body\">Submitting this form does not automatically result in approval for your leave of absence. You will receive an email or call from our office confirming the LOA once approved.<\/p>\n<p class=\"Body\">The fee for a Leave of Absence is $25.00. All activities missed while on an LOA must be made up at the end of your program. You must continue to make any scheduled program payments while on an LOA.<\/p>\n<p class=\"Body\">If you are unable to attach proof to this request, you may fax, mail, email, or bring the proof to our office <b><span style=\"font-size: 12.0pt;\">prior to the commencement of the LOA. If we do not receive proof we will not be able to approve the LOA. <\/span><\/b><\/p>\n<form method=\"post\" enctype=\"multipart\/form-data\" id=\"vfbp-form-23\" class=\"vfbp-form\"><div style=\"display:none;\"><label for=\"vfbp-EMAIL-AN8fuQyoDLXem\">If you are human, leave this field blank.<\/label><input size=\"25\" autocomplete=\"off\" type=\"text\" name=\"vfbp-EMAIL-AN8fuQyoDLXem\" value=\"\" id=\"\"><\/div><input type=\"hidden\" name=\"_vfb-timestamp-23\" value=\"1779668970\" id=\"\"><input type=\"hidden\" name=\"_vfb-form-id\" value=\"23\" id=\"\"><div class=\"vfb-form-group vfb-col-12\"><div><div class=\"\">Section 1: Client Information<\/div><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-heading\" id=\"vfbField513\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField514\"><div class=\"vfb-form-group\"><label for=\"vfb-field-514\" class=\"vfb-control-label\">Full Name: <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-514\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-514\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-email\" id=\"vfbField515\"><div class=\"vfb-form-group\"><label for=\"vfb-field-515\" class=\"vfb-control-label\">Email Address: <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-515\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"email\" name=\"vfb-field-515\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-email\" id=\"vfbField516\"><div class=\"vfb-form-group\"><label for=\"vfb-field-516\" class=\"vfb-control-label\">Confirm Email Address: <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-516\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"email\" name=\"vfb-field-516\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-phone\" id=\"vfbField517\"><div class=\"vfb-form-group\"><label for=\"vfb-field-517\" class=\"vfb-control-label\">Primary Phone Number <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-517\" class=\"vfb-form-control vfb-intl-phone\" placeholder=\"\" required=\"required\" type=\"tel\" name=\"vfb-field-517\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-form-group vfb-col-12\"><div><div class=\"\">Section 2: Program Location<\/div><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-heading\" id=\"vfbField518\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-checkbox\" id=\"vfbField519\"><label for=\"vfb-field-519\" class=\"vfb-control-label\">Identify which Sacramento County Breining Institute DUI Program location you are attending: <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-519-0\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-519\" required=\"required\" type=\"checkbox\" name=\"vfb-field-519[0]\" value=\"1\">NORTH COUNTY: 8894 Greenback Lane, Orangevale<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-519-1\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-519\" type=\"checkbox\" name=\"vfb-field-519[1]\" value=\"1\">FOLSOM: 2360 E. Bidwell Street, Suite 107, Folsom<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-519-2\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-519\" type=\"checkbox\" name=\"vfb-field-519[2]\" value=\"1\">MID-COUNTY: 2775 Cottage Way, Suite 25, Sacramento<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-519-3\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-519\" type=\"checkbox\" name=\"vfb-field-519[3]\" value=\"1\">SOUTH COUNTY: 3159 Dwight Road, Suite 100, Elk Grove<\/label><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-date\" id=\"vfbField951\"><div class=\"vfb-form-group\"><label for=\"vfb-field-951\" class=\"vfb-control-label\">What is the starting date for your requested Leave of Absence? <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-951\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" data-provide=\"datepicker\" type=\"text\" name=\"vfb-field-951\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-date\" id=\"vfbField952\"><div class=\"vfb-form-group\"><label for=\"vfb-field-952\" class=\"vfb-control-label\">What is the ending date for your requested Leave of Absence? <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-952\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" data-provide=\"datepicker\" type=\"text\" name=\"vfb-field-952\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-checkbox\" id=\"vfbField520\"><label for=\"vfb-field-520\" class=\"vfb-control-label\">Identify the reason you are making this request for a Leave of Absence.<\/label><div><span class=\"vfb-help-block\">You may select more than one reason.<\/span><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-520-0\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-520\" type=\"checkbox\" name=\"vfb-field-520[0]\" value=\"1\">Travel for work.<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-520-1\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-520\" type=\"checkbox\" name=\"vfb-field-520[1]\" value=\"1\">Military duties.<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-520-2\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-520\" type=\"checkbox\" name=\"vfb-field-520[2]\" value=\"1\">Illness or family illness.<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-520-3\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-520\" type=\"checkbox\" name=\"vfb-field-520[3]\" value=\"1\">Incarceration including home arrest (the $25.00 fee is waived for incarceration LOAs).<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-520-4\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-520\" type=\"checkbox\" name=\"vfb-field-520[4]\" value=\"1\">Extreme personal hardship or family emergency.<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-520-5\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-520\" type=\"checkbox\" name=\"vfb-field-520[5]\" value=\"1\">Vacation (client must make up all absences and be up to date on all payments to request an LOA for this reason).<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-520-6\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-520\" type=\"checkbox\" name=\"vfb-field-520[6]\" value=\"1\">Other reason, identified below in Section 3.<\/label><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-form-group vfb-col-12\"><div><div class=\"\">Section 3: Other reason for Leave of Absence request.<\/div><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-heading\" id=\"vfbField521\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-textarea\" id=\"vfbField522\"><div class=\"vfb-form-group\"><label for=\"vfb-field-522\" class=\"vfb-control-label\">If there is another reason you are requesting an LOA which is not identified above, please explain it here:<\/label><div><textarea id=\"vfb-field-522\" class=\"vfb-form-control\" placeholder=\"\" rows=\"10\" name=\"vfb-field-522\" cols=\"50\"><\/textarea><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-file-upload\" id=\"vfbField532\"><div class=\"vfb-form-group\"><label for=\"vfb-field-532\" class=\"vfb-control-label\">File Upload (if applicable)<\/label><div><span class=\"vfb-help-block\">If applicable, you may upload your documentation here:<\/span><input id=\"vfb-field-532\" class=\"vfb-form-control vfb-file-input\" placeholder=\"\" type=\"file\" name=\"vfb-field-532\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-form-group vfb-col-12\"><div><div class=\"\">Section 4: Credit Card and Payment Information<\/div><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-heading\" id=\"vfbField523\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-instructions\" id=\"vfbField524\"><div class=\"vfb-form-group\"><label for=\"vfb-field-524\" class=\"vfb-control-label\">You give permission to and authorize Breining Institute to charge the twenty-five dollar ($25.00) Leave of Absence (LOA) fee to the following credit card:<\/label><div class=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-radio\" id=\"vfbField525\"><label for=\"vfb-field-525\" class=\"vfb-control-label\">Credit Card: <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"vfb-radio\"><label><input id=\"vfb-field-525-0\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-525\" value=\"VISA\">VISA<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-525-1\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-525\" value=\"MasterCard\">MasterCard<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-525-2\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-525\" value=\"Discover\">Discover<\/label><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-number\" id=\"vfbField526\"><div class=\"vfb-form-group\"><label for=\"vfb-field-526\" class=\"vfb-control-label\">Credit Card Number: <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-526\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"number\" name=\"vfb-field-526\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField527\"><div class=\"vfb-form-group\"><label for=\"vfb-field-527\" class=\"vfb-control-label\">Full Name on Credit Card: <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-527\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-527\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField528\"><div class=\"vfb-form-group\"><label for=\"vfb-field-528\" class=\"vfb-control-label\">Credit Card Expiration Date <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-528\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-528\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-captcha\" id=\"vfbField530\"><div class=\"vfb-form-group\"><label for=\"vfb-field-530\" class=\"vfb-control-label\">Captcha <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"g-recaptcha\" data-sitekey=\"6LdWgN0UAAAAAM_hb1SqmzT2DP4J1X289K2epOVA\"><\/div><input type=\"hidden\" name=\"_vfb_recaptcha_enabled\" value=\"1\" id=\"\"><div class=\"vfb-has-error\" id=\"vfb-recaptcha-error\"><span class=\"vfb-help-block\">reCAPTCHA is required.<\/span><\/div><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-submit\" id=\"vfbField529\"><button id=\"vfb-field-529\" class=\" btn btn-primary\" placeholder=\"\" type=\"submit\" name=\"_vfb-submit\">Submit<\/button><\/div><div class=\"vfb-clearfix\"><\/div><\/form>\n","protected":false},"excerpt":{"rendered":"<p>You may submit this form to request a Leave of Absence (LOA) for the following reasons: Travel for work Military duties Illness or family illness Incarceration including home arrest (the $25.00 fee is waived for incarceration LOAs) Extreme personal hardship or family emergency You must submit the request for the LOA at least 24 hours [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":528,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-3151","page","type-page","status-publish","czr-hentry"],"_links":{"self":[{"href":"https:\/\/www.breining.edu\/index.php\/wp-json\/wp\/v2\/pages\/3151","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.breining.edu\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.breining.edu\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.breining.edu\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.breining.edu\/index.php\/wp-json\/wp\/v2\/comments?post=3151"}],"version-history":[{"count":2,"href":"https:\/\/www.breining.edu\/index.php\/wp-json\/wp\/v2\/pages\/3151\/revisions"}],"predecessor-version":[{"id":3155,"href":"https:\/\/www.breining.edu\/index.php\/wp-json\/wp\/v2\/pages\/3151\/revisions\/3155"}],"up":[{"embeddable":true,"href":"https:\/\/www.breining.edu\/index.php\/wp-json\/wp\/v2\/pages\/528"}],"wp:attachment":[{"href":"https:\/\/www.breining.edu\/index.php\/wp-json\/wp\/v2\/media?parent=3151"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}