ABSENCE NOTICE
EMPLOYEE’S NAME: PERIOD OF ABSENCE: a.m. From: p.m. time CHARGE TO: Vacation ................................................................................................ Sick Leave ........ Family Care ........ Family Death ..............
to: date time
a.m. p.m. date # HOURS
Leave Without Pay ............................................................................... Compensatory Time Off ...................................................................... REASON (for item checked above):
Employee’s signature
D1371 (7/79) CALCODE 71461-107
Department approval signature
ebdfe73f-c44e-4db0-bb47-a3ea774b0068.doc