STAFF ABSENCE FORM
Please complete this form every time that you are going to be absent from your job. This form does not negate the process that your supervisor has in place; it is in addition to that process. This form will be used by payroll to verify the days that you are absent, the type of leave taken (sick, personal, etc) and will be compared to the monthly report submitted by the bookkeeper and principal/supervisor. If your leave is for 10 or more days, then you must submit a Leave of Absence Request (MPS form 108-2017).
Email address *
Work Location *
Employee ID number or last four digits of your social security number *
First and last name as it appears on your social security card *
Beginning Date of Absence *
MM
/
DD
/
YYYY
Ending date of absence *
MM
/
DD
/
YYYY
Total days absent *
If any of the days above are half days, please list the dates of the half days.
Reason for Absence *
If you are using a combination of reasons, for each date, specify the reason for absence (e.g. Sept 1st sick leave; Sept 2nd -personal leave)
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Montgomery Public Schools. Report Abuse