Â鶹´«Ã½
Dept. of Human Services Absence Notification Form - Unit A & B
Dept. of Human Services Absence Notification Form - Unit A & B
Name:
Name:
*
First
Last
Email:
*
Employment Status:
*
Employment Status:
Unit A Faculty
Unit B Faculty
Date of Absence
Date of Absence
*
/
MM
/
DD
YYYY
Type of Used Leave:
*
Type of Used Leave:
Accrued Leave
Sick Leave (up to 5 days per academic year)
Family Sick Leave (FMLA)
Personal Leave (up to 5 days per year)
Bereavement Leave (up to 5 days per occurance)
Court Required Leave
Leave without Salary
Travel
Other
Other
Total Hours:
Leave Reported in Quarter-Hour Increments
*
Date of Absence
Date of Absence
/
MM
/
DD
YYYY
Type of Used Leave:
Type of Used Leave:
Accrued Leave
Sick Leave (up to 5 days per academic year)
Family Sick Leave (FMLA)
Personal Leave (up to 5 days per year)
Bereavement Leave (up to 5 days per occurance)
Court Required Leave
Leave without Salary
Travel
Other
Other
Total Hours:
Leave Reported in Quarter-Hour Increments
Date of Absence
Date of Absence
/
MM
/
DD
YYYY
Type of Used Leave:
Type of Used Leave:
Accrued Leave
Sick Leave (up to 5 days per academic year)
Family Sick Leave (FMLA)
Personal Leave (up to 5 days per year)
Bereavement Leave (up to 5 days per occurance)
Court Required Leave
Leave without Salary
Travel
Other
Other
Total Hours:
Leave Reported in Quarter-Hour Increments
Date of Absence
Date of Absence
/
MM
/
DD
YYYY
Type of Used Leave:
Type of Used Leave:
Accrued Leave
Sick Leave (uo to 5 days per academic year)
Family Sick Leave (FMLA)
Personal Leave (up to 5 days per year)
Bereavement Leave (up to 5 days per occurance)
Court Required Leave
Leave without Salary
Travel
Other
Other
Total Hours:
Leave Reported in Quarter-Hour Increments
Date of Absence
Date of Absence
/
MM
/
DD
YYYY
Type of Used Leave:
Type of Used Leave:
Accrued Leave
Sick Leave (up to 5 days per academci year)
Family Sick Leave (FMLA)
Personal Leave (up to 5 days per year)
Bereavement Leave (up to 5 days per occurance)
Court Required Leave
Leave without Salary
Travel
Other
Other
Total Hours:
Leave Reported in Quarter-Hour Increments
List these dates/times here if a full day (7.5 hours) was not taken for any of these (e.g., 3/1/24 gone from 2-4:30pm and missed office hours).
*
How are you covering your responsibilities while absent?
Example: GA Coverage, Online Assignment
*
If you need a message posted on your office or classroom door, provide the room number and message text.
*