Employee'sAbsenceRep.qk 8/1/05 10:50 AM Page 1
UNION COUNTY VOCATIONAL-TECHNICAL SCHOOLS
EMPLOYEE’S ABSENCE REPORT
NAME OF EMPLOYEE __________________________________________ POSITION ____________________
TIME OF ABSENCE (Submit a SEPARATE report for EACH MONTH in which an absence occurs):
MONTH ___________
20_____
DATE(S) ______________________________
TOTAL NO. OF DAYS______
REASON FOR ABSENCE(S): (Submit a SEPARATE report for EACH CAUSE of absence)
( ( ( ( (
) ) ) ) )
ILLNESS* ( PERSONAL BUSINESS ( VACATION ( ACCIDENT ON DUTY BEREAVEMENT (SPECIFY RELATIONSHIP) ( _____________________________________ (
) ) ) ) )
JURY DUTY LEAVE OF ABSENCE PROFESSIONAL (SPECIFY) _________________________________________________ A.M. - INDICATE FOR 1/2 DAY ABSENCE P.M. - INDICATE FOR 1/2 DAY ABSENCE
( ) YES ( ) NO
* A PHYSICIAN’S REPORT FOR ABSENCE HAS BEEN SUBMITTED TO THE SCHOOL NURSE: DATE ____________ EMPLOYEE’S SIGNATURE ______________________________________________________ DATE ____________ SUPERVISOR’S SIGNATURE ____________________________________________________
WHITE/YELLOW - PERSONNEL PINK - PRINCIPAL
SUPERINTENDENT’S APPROVAL ________________________________________
GOLDENROD - EMPLOYEE