Leave Report Form
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OFFICE USE ONLY
LEAVE REPORT FORM
By: _______________
Date: _____________
EMPLOYEE NAME:
EID#: ______________________________ JOB#:_________________________________________
JOB TITLE: ____________________________________
REPORTING CENTER#: ______________
SCHOOL/DEPT:_________________________________
Leave Type:
UPD-Unpaid Leave
PRS-Personal
VAC-Vacation
SCK-Sick Leave
TPD-Temporary Duty
SBK-Sick Bank
WORK
PR
Date of Leave
Reason #
FROM Time
AM
TO Time
AM
HOURS
Leave
DE
Sub Name
Substitute's EID
Use
MM dd yy
*See Back
hh
mm
PM
hh
mm
PM
ABSENT
Type
Use
Job ID
HOURS
(Optional)
PM
990_TPD
PM
TPD
990_TPD
PM
PM
TPD
PM
990_TPD
PM
TPD
990_TPD
PM
PM
TPD
990_TPD
PM
PM
TPD
990_TPD
PM
PM
TPD
PM
990_TPD
PM
TPD
PM
990_TPD
PM
TPD
990_TPD
PM
PM
TPD
990_TPD
PM
PM
TPD
TOTAL WORK HOURS ABSENT:
I certify that the above statements are true to the best of my knowledge.
If this is a Temporary Duty Assignment Request, fill in the following: Purpose and Location:
____________________________________________________________________
____________________________________________________________________
EMPLOYEE SIGNATURE: _________________________________ Date: ______
Estimated Total Cost of Trip: _______________________________________________________________
DEPT DIR/PRIN SIGNATURE: _______________________________ Date: ______
(Designee/Superintendent)
Budget Source: Location [ ]
Grant [ ]
Other (Specify): _______________________________________
Out of State Travel approved by Board on:
___________________________________________________
APPROVED: _______
DISAPPROVED: _______
(Attach Board Agenda)
USER INSTRUCTIONS:
All leave will be reported on this form. Multiple forms may be used in one reporting period. A line on this form must be filled in for each DAY of leave. The dates reported on a single form may be in
more than one reporting period. If you are unsure about the TYPE of leave, locate the proper REASON CODE on the next page. Do not fill in the lines beyond the Leave Type.
34107 - 02/04/10
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