Los Angeles Community College District
FACULTY ABSENCE REPORT Partial Day (Fractional Day)
(Salaried, Full-Time and Adjunct) Location: Department: Instructions: Employee Name: Employee No.
Complete this form and a Absence Certification Request (TA-1). Submit both forms to department supervisor for acknowledgement and routing to College Time Reporting Office.
Absence Total Duty Hours Scheduled Hours 3.00
(Include Office Hours)
Assignment Example: Reason Illness
6.00
% of Day Absent 50%
Date 09/07/07
College LATTC
Remarks:
I certify the absence report noted above.
Employee's Signature and Date
Supervisor's Signature and Date
LACCD Form W-210A 11/08/07
City East Harbor Mission Pierce Southwest Trade-Tech Valley West
Faculty, Regular Adjunct