STATEMENT OF ABSENCE
POWAY UNIFIED SCHOOL
DISTRICT
CHECK IF IRREGULAR WORK SCHEDULE
ADMINISTRATIVE RELEASE TIME/IN-SERVICE-CONFERENCE
If absent more than 5 days, please submit a health care provider’s statement to HR stating the
dates of absences.
(Attendance Cert required)
SICK –
CLASSIFIED: I understand I have exhausted my available sick leave balance and authorize the
payroll department to deduct 50% of pay from my upcoming paycheck while I am on extended
(Copy of orders required)
EXTENDED SICK –
CERTIFICATED
CERTIFICATED: I understand I have exhausted my available sick leave balance and authorize the
payroll department to deduct from my pay the cost of a Substitute while I am on extended sick
(Subpoena required)
Date of Injury:
W/O PAY
I understand I have exhausted my available vacation balance and authorize leave without pay
from my upcoming paycheck.
Relationship:
In State miles traveled:
W/O PAY
I authorize leave without pay from my upcoming paycheck.
Out of State:
Qualifying reason/Relationship:
*PLEASE INDICATE ASSIGNED CONTRACTED HOURS PER DAY
ALL LEAVE TYPES: REFER TO CONTRACT FOR DETAILED INFORMATION ON USAGE
IF EMPLOYEE IS UNAVAILABLE FOR SIGNATURE SUBMIT P9 TO PAYROLL AS SOON AS POSSIBLE
Qualifying reason/Relationship:
Employee Signature and Date
Supervisor/Administrator Signature and Date
Section below is for Payroll Department Use only
$ AMOUNT DEDUCTED MONTH PAYCHECK ADJUSTED
PAYROLL TECH AND EXTENSION
PUSD P-9 (Rev. 7/18)
