Fillable Faculty Absence Report Form 000 (Las Positas College)

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Faculty Absence Report Form 000 (Las Positas College)

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HR|AbsenceReportForm updated 4 11 16 Page1 of 1
Instructions: Faculty members are required to record on this form any absence for any reason from obligatory
duties and responsibilities. This is the basic form used for payroll.
Location: Chabot College Las Positas College District Office
Office: Academic Services Student Personnel Other
(Please Print)
Submitted by:
W#
(Faculty member)
Date(s) of Absence: ________________________________________________________
Reason for absence:
Conference Administrative Industrial Accident (report to be filed with Business Office)
Contract leaves: (complete “request for leave” form for all but personal illness)
Personal sickness or injury
Personal necessity (deduct from sick leave)
reason: ______________________
Note: refer to collective bargaining agreement for eligibility and coverage.
Period of absence: Full day Partial workday Hourly part-time
If a salaried employee, indicate percentage (%) of day absent: __________%
If an hourly-paid employee, indicate number of hours absent: ________ hours
Course #
and Section
Lecture
or Lab
Time
Hours
Substitute’s
signature
and W #
Class
cancelled
Combined
or other
or
or
or
or
or
or
Faculty member signature: ___________________________________ Date: ____/____/____
Division Dean’s signature: ____________________________________ Date: ____/____/____
Division Dean’s Contact #:__(_____)_______________
Distribution:
Please send original form to faculty member and substitutes for signature. Return to office location immediately for processing.
Division Dean’s Office please provide contact number in case Payroll has questions and submit signed copies to payroll for
processing. This is the basis for payment. If substitution is less than thirty (30) minutes, payment will not be made; box above
should be checked “class cancelled” or “combined or other”
Reference: Article 11A, 11A.2F, 11.A.4, 11B, 11C, 11D, 11E.1, 11F, 11G, 11H, 11I – Faculty Collective Bargaining Agreement
CHABOT-LAS POSITAS COMMUNITY COLLEGE DISTRICT
Office of Human Resources
Absence Report Form
Bereavement
Maternity leave
Judicial Leave
Military Leave
Leave without pay
Personal (contract faculty only)
Other: ______________
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Faculty Absence Report Form 000 (Las Positas College)

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Completed 24 July 2020

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