EMPLOYEE’S SIGNATURE
SUPERVISOR'S SIGNATURE
TOTAL BENEFIT
DAYS
BENEFIT TIME
OTHER
TOTALS FOR
THE MONTH
SICK DAYS
TAKEN
VACATION DAYS
TAKEN
DATE(S)
*CODE
DAYS
Name:
Month Ending:
Acct.:
DO NOT WRITE IN THIS AREA
VAC
PERS
SICK
OTHER
TOTAL
I CERTIFY THAT THE ABOVE DAYS ARE CORRECT:
*For other leave time, insert the applicable code:
AL Administrative Leave J Jury Duty
F Funeral Leave SA Spotlight Award Day
MP Performance Bonus Day UL Unpaid Leave
PH Personal Holiday
*Please note this form is not intended for use during personal or FMLA leave.
Contact Human Resources for further information.
Dept.:
CARS ID:
Monthly Absence Reporting
Salaried Employees
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