YOSEMITE COMMUNITY COLLEGE DISTRICT
Human Resources Operations
CERTIFICATE OF ABSENCE FOR FACULTY
Name of Employee _________________________________ Colleague ID # _________________
(PRINT LEGAL NAME)
Dept: __________________ Check one: MJC CC Month/Year ___________________
Check One: Full-Time Faculty or Adjunct Overload
Sick Leave
• Full Time Faculty (please list the total hours each day PLUS required responsibility hours for that day)
• Adjunct Faculty (please list total hours)
Personal Necessity Leave
Other – Specify below
•
(include relationship to deceased)
• Community Service Leave (up to 3 days per academic year)
•
Judicial & Court Appearance
(attach supporting form and check for paid services),
Military Leave (MILI)
Worker’s Comp (attach required medical Certification)
(attach required medical Certification)
Pay Dock (for absence not covered under above categories)
ITEMIZE DATES & HOURS Per Day
DATE(S)
HOURS
(to nearest .25 hr)
LEAVE TYPE
NOTES/COMMENTS
• FT Faculty may elect to use not more than six (6) days per year of unused
sick leave for purposes of Personal Necessity leave.
Adjunct/Overload:
• Sick Leave Credit may be utilized for reasons of personal necessity by
faculty employed on an hourly basis, at the rate of one (1) for each thirty (30)
hours of paid service.
Forward signed original to HR Operations.
Please make a copy for you records.
______________________________________________
Employee Signature Date
______________________________________________
Immediate Management Supervisor Date
