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ESU #17 Absence Report
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* Required
Name
*
Your answer
Email Address
*
Your answer
Date1
*
MM
/
DD
/
YYYY
Date2
*
MM
/
DD
/
YYYY
Date3
*
Enter the number of days missed to the nearest quarter day, e.g., "0.25" for 2 hours, "2.0" for 2 days, etc.
Your answer
Time Absent1
*
Indicate the clock time marking the BEGINNING of your absence.
Choose
7:00 a.m.
7:30 a.m.
8:00 a.m.
8:30 a.m.
9:00 a.m.
9:30 a.m.
10:00 a.m.
10:30 a.m.
11:00 a.m.
11:30 a.m.
12:00 p.m.
12:30 p.m.
1:00 p.m.
1:30 p.m.
2:00 p.m.
2:30 p.m.
3:00 p.m.
3:30 p.m.
4:00 p.m.
4:30 p.m.
5:00 p.m.
Time Absent2
*
Indicate the clock time marking the END of your absence.
Choose
7:00 a.m.
7:30 a.m.
8:00 a.m.
8:30 a.m.
9:00 a.m.
9:30 a.m.
10:00 a.m.
10:30 a.m.
11:00 a.m.
11:30 a.m.
12:00 p.m.
12:30 p.m.
1:00 p.m.
1:30 p.m.
2:00 p.m.
2:30 p.m.
3:00 p.m.
3:30 p.m.
4:00 p.m.
4:30 p.m.
5:00 p.m.
Reason
*
Illness/Bereavement
Leave without pay
Personal Time
Vacation
Explanation
*
Your answer
Prepared by
*
Your answer
Approved by
(for office use only)
Your answer
Notification
*
Select Jan Foster's Email address below in order for her to receive notification of this Absence Report. ESUCC staff please select both.
janfoster@esu17.org
,
gerickson17@esu17.org
dhericks@esucc.org
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