Lincoln Intermediate Unit No - DOC by HC120913215913


									Lincoln Intermediate Unit No. 12
P.O. Box 70
New Oxford, PA 17350
(717) 624-6441
                                           Employee Absence Report
Supervisor: Tom Mesler/Mike Thew_____________________
1.   Employee is responsible for completing all requested information.
2.   Form must be typed or written legibly and sent to your supervisor.
3.   Form must be submitted immediately upon returning to work in cases of emergency and bereavement.
4.   When requesting Personal, Professional, or IEP Leave, the form should be submitted at least three business days
     prior to the intended absence.
5.   No form needs to be completed for sick days or family sick days.
6.   If not approved, you will be notified as soon as possible via mail or telephone by your supervisor.
7.   Form must be signed by the employee.
8.   If you’re not going to take the day, or if the day is cancelled due to weather, re-do the paperwork and mark
     under “Cancel Day(s)”. If your position requires a substitute, please notify the substitute registry of your
9.   If the form is faxed, do NOT mail the original.

Employee Name                                                      Employee Position

Program                                                            Location/School District

Date(s) Absent                                                     Total Days

Substitute Required:        Yes           No          If Yes:
                                                                   Starting Time              Ending Time
     Reason For Absence                                             Reason For Absence

     Vacation                                                       IEP

     Personal – Unaccounted days shall not be used on               Bereavement
     the day immediately preceding or immediately
     following a holiday vacation. Classroom staff
     cannot use personal days the first ten or last ten
     days of school.
     Professional– (Name of Meeting/Conference)
                                                                    Jury Duty

     Emergency (professional staff only)                            Other

     Please Explain                                                 Please Explain

     Cancel Day(s) (please highlight)

Employee’s Signature                                                Date

     Approved                 Not Approved
                                                                Supervisor’s Signature                  Date

LIU-24 (Revised 6/06)

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