[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
Provide additional details about the rea