Beginning Date: Department: Employee Name: Classification: Hours Per Month Annual Accrual Rate: Employee ID:
Ending Date:
Date Employed: Effective Date-Classification: Hours Per Month Sick Accrual Rate:
1 Annual: Sick: Military: Jury: Holiday: *Absence without leave pay: **Other:
2
3
4
5
6
7
8
9
Dates and Hours of Leave Taken 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Total: 0.0 0.0 0.0 0.0 0.0
0.0 0.0
Beginning Balance ( In Hours) Annual: Sick: Termination:
(Less) Leave Taken (Total Hours from Above) 0.0 0.0
(Add) Monthly Accrual ( In Hours)
Balance Forwarded ( In Hours) 0.0 0.0
annual hours paid as lump sum payment
* E- Excused Check One: * * Specify:
U - Unexcused Excused Unexcused
Note: This report is to be completed for ALL absence and leave taken by a university employee. Signature of employee indicates verification of absence or leave. Supervisor or Department Chair’s signature indicates approval of hours taken and certifies that the above report accurately reflects all hours taken by employee during reporting period. This report is to be returned to the Payroll Office no later than the 8 th calendar day of the month following reporting period listed above
Employee's Signature
Supervisor or Department Chair’s Signature