YOSEMITE COMMUNITY COLLEGE DISTRICT
Human Resources Operations
CERTIFICATE OF ABSENCE FOR CLASSIFIED STAFF
Name of Employee ___________________________________ Colleague ID #____________
(PRINT LEGAL NAME)
Dept. _____________ Check: MJC CC CS Month/Year ____________
LIST TOTAL HOURS ABSENT:
Sick Leave _____________________________
Vacation ______________________________
Comp Time ___________________________
Pay Dock _____________________________
Floating Holiday ________________________
Other
________________________________
• Bereavement (include relationship to deceased)
• Funeral (include name of deceased YCCD employee/retiree)
• Jury Duty/Govt Agency Appearance (attach supporting form and
check for paid services)
• Military
Off Duty / Off Pay ______________________
Personal Necessity _____________________
Personal necessity leave shall be used for circumstances which cannot be
expected to be disregarded, necessitate immediate attention, and which
cannot be dealt with during off duty hours.
Personal Business ____________________
Up to two (2) days of Personal Necessity Leave may be used for absences
as a result of personal business.
Extended Sick ________________________
Attach medical certification
Workers Comp ________________________
Attach medical certification
ITEMIZE DATES & HOURS ABSENT EACH DAY (Please do a separate form each month)
DATE(S)
MO/DT/YEAR
HOURS
(rounded to
nearest 1/4 hr)
LEAVE TYPE
EXPLANATION (required for PN or ‘Other’)
Employee Signature Date
Forward signed original to Human Resources Operations.
Please make a copy for your records.
Immediate Management Supervisor Date
Signature of President Date
(Required for approval of Personal Necessity or Personal Business Leave)
