REQUEST FOR AND REPORT OF TIME OFF DUTY
This for
m is to be completed by all employees immediately upon return to duty following an absence
due to sickness. All other leaves must be approved on this form in advance.
Employe
e Name: _______________________________ Banner ID: _______________________
Department: ___________________________________
DATES(S) OF ABSENCE
LEAVE CODE
NUMBER OF HOURS
LEAVE CODES
(BER) Bereavement Relation to deceased: ______________________________________
(CTT) Compensatory Time Taken
(FIL) Family Illness
(HOF) Floating Holiday
(JUR) Jury Duty
(LWP) Leave Without Pay
(VAC) Vacation
(PEB) Personal Business
(PEN) Personal Necessity
(SIC) Sick
(UNB) Union Business
(WCP) Worker’s Compensation
(CTE)
Compensatory Time Earned
Approvals
Employee: After completion of information above, insert name and date and route to immediate
supervisor for approval via email.
Employee: Date:
Supervisor: Please insert name and date, indicating approval. For Management, route via email to
payroll@cuesta.edu for processing with a copy to the employee for their records.
Superv
isor: Date:
Email Routing Instructions:
After completion of form, click File Send To Mail Recipient (as
Attachment). Choose the recipients email address and send.