91³Ô¹ÏÍø
Dept. of Human Services Absence Notification Form - Civil Service
Dept. of Human Services Absence Notification Form - Civil Service
Name:
Name:
*
First
Last
Email:
*
Date of Absence:
Date of Absence:
*
/
MM
/
DD
YYYY
Type of Used Leave:
*
Type of Used Leave:
Sick Leave
Vacation
Court Required Leave
Bereavement Leave (3 days per occurance)
Family Medical Leave (FMLA)
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:
Sick Leave
Vacation
Court Required Leave
Bereavement Leave (3 days per occurance)
Family Medical Leave (FMLA)
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:
Sick Leave
Vacation
Court Required Leave
Bereavement Leave (3 days per occurance)
Family Medical Leave (FMLA)
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:
Sick Leave
Vacation
Court Required Leave
Bereavement Leave (3 days per occurance)
Family Medical Leave (FMLA)
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:
Sick Leave
Vacation
Court Required Leave
Bereavement Leave (3 days per occurance)
Family Medical Leave (FMLA)
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)