Lincoln Intermediate Unit No. 12
P.O. Box 70
New Oxford, PA 17350
Employee Absence Report
1. Employee is responsible for completing all requested information.
2. Form must be typed or written legibly, signed and sent to your supervisor.
3. If not approved, you will be notified as soon as possible via LIU email or telephone
by your supervisor.
4. If you are 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, notify the substitute coordinator (624.6603 or firstname.lastname@example.org) of your
5. If the form is faxed to your Supervisor, do NOT mail the original.
Employee Name Employee Position
Program Location/School District
Date(s) Absent Total Days Hours worked/day
Substitute Required: Yes No If Yes:
Starting Time Ending Time
Reason For Absence
Cancel Day(s) (please highlight)
Employee’s Signature Date
Approved Not Approved
Supervisor’s Signature Date
When form is completed and signed by Supervisor,
please forward to Human Resources.
Human Resources will enter any comp time used into the
Aesop system for the employee.
LIU-24 (Revised 4/2012)