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Dept. of Human Services Absence Notification Form - Academic Support Professional
Dept. of Human Services Absence Notification Form - Academic Support Professional
Name:
Name:
*
First
Last
Email:
*
Date of Absence:
Date of Absence:
*
/
MM
/
DD
YYYY
Type of Used Leave:
*
Type of Used Leave:
Break Day
Bereavement Leave (5 days per occurance)
Sick Leave Non-Cumulative (10 days per year)
Sick Leave Non-Payable (5 days per year)
Court Required Leave
Personal Day (5 days per year)
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:
Break Day (Vacation)
Bereavement Leave (5 days per occurance)
Sick Leave Non-Cumulative (10 days per year)
Sick Leave Non-Payable (5 days per year)
Court Required Leave
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:
Break Day (Vacation)
Bereavement Leave (5 days per occurance)
Sick Leave Non-Cumulative (10 days per year)
Sick Leave Non-Payable (5 days per year)
Court Required Leave
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:
Break Day (Vacation)
Bereavement Leave (5 days per occurance)
Sick Leave Non-Cumulative (10 days per year)
Sick Leave Non-Payable (5 days per year)
Court Required Leave
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:
Break Day (Vacation)
Bereavement Leave (5 days per occurance)
Sick Leave Non-Cumulative (10 days per year)
Sick Leave Non-Payable (5 days per year)
Court Required Leave
Total Hours:
Leave Reported in Quarter-Hour Increments
List the days/times you were absent if you were not absent a whole day (e.g., 3/1/24 - Gone from 1-4:30)
*