ABSENTEE REPORTING FORM
Employee Name
*
First Name
Last Name
Date(s) of Absence
*
/
Month
/
Day
Year
Date
Additional Date
/
Month
/
Day
Year
Date
Additional Date 2
/
Month
/
Day
Year
Date
Total Hours Absent:
*
PURPOSE:
Sick Leave Hours:
Vacation Hours:
Floating Holiday Hours:
Personal Leave Hours:
Jury Duty Hours:
Funeral Leave Hours
Relationship:
Family Medical Leave Hours:
Purpose:
On the Job Injury:
Authorized Leave: From:
To:
Authorized Signature:
I will be absent:
Date
-
Month
-
Day
Year
Date
From:
To:
Date
-
Month
-
Day
Year
Date
From:
To:
Remarks:
Leave Approved by: (1st approval)
blanks
(2nd approval)
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