Absence From Duty

Absence From Duty

Custodial, Groundskeeper, Maintenance
Employee Name*

First NameLast Name
Today's Date

MonthDayYear
Date
Applicaton is hereby made for approval of absence from duty for the period.
Beginning Date

MonthDayYear
Date
Ending Date

MonthDayYear
Date
Total Day(s) Absent
Reason for Absence

SickPersonalVacationCompDockedOther
Note: Scheduled 10 hr. work days equivalent to 1.25 days.
Facts concerning the above absence from duty
I hereby certify that the foregoing statement is true and correct.
Employees must report their absence as soon as they return to work. If the absence lasted five or more consecutive workdays, a written statement from the attending physician must also be submit.
Employee Signature*

Clear
Employee Email*
example@example.com
Should be Empty: