College Station Independent School District Absence from Duty Report

Employee ID#:__________________________________

Date:_____________________

Full Name of Employee:____________________________________________ Last Name

First Name

Kids Klub Work Location:__________________

MI

Part Full - _______ No. of Hours Absent: ________ Absence Requested:_____________________________________________

Full/Part Day Time Date (MM/DD/Year) Reason for Absence: [Be Specific- i.e., note personal illness, personal injury (caused by accident), illness of family member (note the relationship), death in family (note the relationship), etc.] __________________________________ _________________________________________________________________________________________________

____________________________________________ Signature of Employee

Code Type:

Type of Absence:

No. of Hours:

*040

Personal Illness

___________

*041

Personal Injury (caused by accident)

___________

*042

Family Illness

___________

*043

Death in Family

___________

*044

Family Medical Leave Act

___________

053

Conferences/Workshops/Staff Development

___________

060

Civic Leave (Jury Duty-attach copy of summons)

___________

070

Vacation (12 month employees)

___________

075

State Discretionary (Personal) Leave

___________

090

Reduction of Pay (Dock)

___________ Total Hours:

___________ st

* Absences for code types 040, 041, 042, 043, or 044 will be taken from leave accumulation sources in the following order of availability: 1 - Local nd rd Non-Discretionary (Sick) Leave; 2 - State Non-Discretionary (Sick) Leave; 3 - State-Discretionary (Personal) Leave, unless designates a different order of use.

__________________________________ Signature of Principal/Supervisor

_____________ Date