EMPLOYEE’S ABSENCE REPORT
NAME OF EMPLOYEE __________________________________________
POSITION ____________________
TIME OF ABSENCE (Submit a SEPARATE report for EACH MONTH in which an absence occurs):
MONTH ___________ 20_____ DATE(S) ______________________________ TOTAL NO. OF DAYS______
REASON FOR ABSENCE(S): (Submit a SEPARATE report for EACH CAUSE of absence)
( )
ILLNESS*
( )
JURY DUTY
( ) PERSONAL BUSINESS
( )
LEAVE OF ABSENCE
( ) VACATION
( )
PROFESSIONAL (SPECIFY)
( ) ACCIDENT ON DUTY
_________________________________________________
( ) BEREAVEMENT (SPECIFY RELATIONSHIP) ( ) A.M. - INDICATE FOR 1/2 DAY ABSENCE
_____________________________________ ( )
P.M. - INDICATE FOR 1/2 DAY ABSENCE
* A PHYSICIAN’S REPORT FOR ABSENCE HAS BEEN SUBMITTED TO THE SCHOOL NURSE: ( ) YES ( ) NO
EMPLOYEE’S SIGNATURE ______________________________________________________
SUPERVISOR’S SIGNATURE ____________________________________________________
WHITE/YELLOW - PERSONNEL
PINK - PRINCIPAL
GOLDENROD - EMPLOYEE
DATE ____________
DATE ____________
SUPERINTENDENT’S APPROVAL
________________________________________
UNION COUNTY VOCATIONAL-TECHNICAL SCHOOLS
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