Faculty Time Off/Sick Time Form
All Xavier faculty/teachers should use this form for time off/sick time.
IMPORTANT:
The Business Office will receive your form upon submission.
Employee's Name
*
Employee's Position
*
Employee's Email
*
example@example.com
Date of Absence
*
-
Month
-
Day
Year
Date
Time Leaving (if partial day)
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Time Returning (if partial day)
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Department Chair
*
First Name
Last Name
Department Chair's Email (They will get an email with this information to send to Business Office with their approval)
*
example@example.com
Please complete each column:
*
Rows
Period
Course
Room
Sub Needed? Y/N
Please List
Please List
Please List
Please List
Please List
Will you be missing CP?
*
Yes
No
Will you be missing an assigned proctoring duty?
*
Yes
No
Reason for Time Off/Sick Time
Please select the non-Xavier related reason or Xavier related reason (which section applies to your request)
Non Xavier related reason (please select that apply)
Sick Time (self) return within 24 hours of absence
Bereavement
Military
Jury Duty (unpaid)
Maternity/Paternity (paid through state disability)
Sick Time (family) return within 24 hours of absence
Off Campus Appointment
Xavier related reason (please check below)
Conference/Colloquium
Athletics
Retreat/Immersion
Off Campus Appointment
Submit
Xavier College Prep
*
Should be Empty: