Employee Absence Report and Summary by LegalZoom

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									[COMPANY NAME] Employee Absence Report
Date: ______________________________ Report completed by Name: Title: Phone No: (

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EMPLOYEE INFORMATION Full Name: Employee ID:  Male  Female Street Address: City: Job Description/Title: Supervisor: Department: State: Apt: Zip Code: Hire Date: Birth Date:

DESCRIPTION OF ABSENCE(S) Date(s) of absence: Absence was:  with pay  without pay Reason for absence:         Sick Leave (self) Sick Leave (family illness) Jury Duty (attach copy of summons) Bereavement Leave Holiday Vacation Personal Leave Other

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