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).
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
Ending date of absence
Total days absent
If any of the days above are half days, please list the dates of the half days.
Reason for Absence
Vacation (if applicable)
Combination (If you are using a combination of reasons, please explain in the next question)
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)
Send me a copy of my responses.
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This form was created inside of Montgomery Public Schools.