Report Of Absence printable pdf download

Report Of Absence

AUGLAIZE COUNTY EDUCATIONAL SERVICE CENTER

REPORT OF ABSENCE - CERTIFIED/NON-CERTIFIED EMPLOYEES

Must be completed 24 hours after employee returns to work. Treasurers cannot legally pay employees claiming sick leave,

unless this form has been properly completed and approved. This form is required to comply with the Ohio Revised Code.

If you are an hourly (classified) employee, please record your absence in number of hours.

EMPLOYEE:

Total Number of Days/Hours:

Building (unit) work:

Job Position:

REASON FOR ABSENCE:

1. Personal Illness/doctor appt.:

Day and Date (s)

2. Member of Family Illness/doctor appt.:

Relationship:

Day and Date (s)

3. Death in Family:

Relationship:

Day and Date (s)

4. Personal Leave: (Must be approved three days in advance)

Day and Date (s)

5. Professional Meeting:

(Description or Title of Activity)

Day and Date (s)

6. Vacation: (for 11 & 12 month employees only)

Date (s)

7. Other:

Explain:

How many days (certified staff) or hours (classified staff) of absence listed above should be charged to the following:

Days (certified staff)

Hours (classified staff)

Sick Leave:

Personal Leave:

Deducted From Paycheck:

Vacation Leave:

(for 11 & 12 month employees only)

Employee Signature:

Date:

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APPROVAL:

Supervisor:

Date:

Superintendent:

Date:

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SUBSTITUTE:

Name of Substitute:

Report Of Absence

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