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 (Vacation) Sick Leave Non-Cumulative Sick Leave Non-Payable Bereavement Leave (5 Days allowed) 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) Sick Leave Non-Cumulative Sick Leave Non-Payable Bereavement Leave (5 Days allowed) 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) Sick Leave Non-Cumulative Sick Leave Non-Payable Bereavement Leave (5 Days allowed) 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) Sick Leave Non-Cumulative Sick Leave Non-Payable Bereavement Leave (5 Days allowed) 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) Sick Leave Non-Cumulative Sick Leave Non-Payable Bereavement Leave (5 Days allowed) 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) *