Fillable Associate Faculty Absence Form Fillableform Aug182018 (MiraCosta College)

Fill Online, Printable, Fillable, Blank Associate Faculty Absence Form Fillableform Aug182018 (MiraCosta College) Form

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Associate Faculty Absence Form Fillableform Aug182018 (MiraCosta College)

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Name of Instructor:
Date(s) of Absence:
Instructor absent due to the following:
Illness, Doctor/Dental Appointment School Business (specify):
Time Without Pay Bereavement (state relationship):
Workers' Compensation Personal Necessity Leave (specify):
Healthy Families Leave (AB 1522) Jury Duty (attach attendance slip)
Substitute instructor requested? No Yes; name of substitute:
I certify that all information reported above is correct. I authorize MiraCosta Community College to make any necessary adjustments
due to under/over payment as needed.
For personal necessity leave only, I certify that this absence was due to personal necessity as defined in section 15.4 of the
Associate Faculty Collective Bargaining Agreement.
Instructor signature:
Instructor: After signing this form, please send by interoffice mail to your dean.
Dean's signature:
Payroll Office Use Only:
Payroll ID:
Record Number:
TWOP:
Budget Line:
Revised 08/2018
Date:
MIRACOSTA COLLEGE
ASSOCIATE FACULTY ABSENCE REPORT
Course:
Date:
Total Class Hours Missed:
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Associate Faculty Absence Form Fillableform Aug182018 (MiraCosta College)

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Completed 5 September 2020

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