Fillable QUINCY SCHOOL #144 CLASSIFIED EMPLOYEE ABSENCE REP O

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QUINCY SCHOOL #144 CLASSIFIED EMPLOYEE ABSENCE REP O

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Payroll
O
ffice
Total Hours
Used
:
Amount from Sick
Le
a
v
e
:
(Deduct
A
mo
un
t)
:
Total Hours
x Hourly
R
a
te
= (Amount
Ded
u
cted)
QUINCY SCHOOL
DISTRICT
#144
CLASSIFIED
EMPLOYEE
ABSENCE
REP
O
RT
E
M
PLO
Y
EE
:
E
mployee Name Date(s) of Absence # Days or # Hours
I R
equest the following leave:
(as per Article IX Leaves)
A. Sick Leave (Check the type below) B. Family Emergency Leave *
F
Jury/Subpoena
Personal Illness, Injury Or Disability Serious Accident
G
Vacation
Maternity/Physicians Certification Serious Illness
H Subbing for Employee
Family Illness* C Bereavement Leave* (Death)
I Physical Attack/Injury
Adoption Paternity D Emergency Leave
J Professional Mtg*
E Personal Leave
K Deduct
* REASON FOR ABSENCE:
Provide
the full name of
co
n
fe
r
e
n
ce,
wo
r
k
s
h
o
p
,
meeting,
sports
event, etc. If
a
b
se
n
ce
is due to immediate family obligation,
provide
the
relationship
(such as
mother,
spouse, child,
e
t
c.)
:
___________________________________________________________________________________________
Employee
Signature
D
a
t
e
RED ROVER - CONFIRMATION # ____________________________
APPROVED DISAPPROVED
Supervisor’s
Signature
D
a
t
e
Building
Secretary:
I
n
i
t
i
a
ls
Substitute/s Used: # Days/Hrs
Revised 12/2021
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QUINCY SCHOOL 144 CLASSIFIED EMPLOYEE ABSENCE REP O

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Completed 9 June 2022

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