ABSENCE REPORT
Name: SS#
Dept: First Date Absent: Date Ret
urned to Work:
Total Days Absent (Must be in 4 or 8 hour a day increments):
Sick:
Vacation:
Reason for Absence:
Explanation:
Faculty Only:
Class(es):
Subject Section Period Time
Subject Section Period Time
Disposition of Class(es):
Approved:
Supervisor: X____________________________ Employee: X
Date: _____________________________ Job Title: ______________________________
Date: ______________________________
Note: Be sure to mark all blanks applicable to your absence and form is signed by Supervisor and employee.
___________________________
Sick Leave Pool
06/2014 MW
I