ࡱ> HJG!` wbjbj\\ 5">>HJJJJJJJ^8:$^^y4|b b b b "#|$@s-u-u-u-A-03$5h]8t39J&]"^"&&3JJb b 34x(x(x(&XJb Jb s-x(&s-x(x(,JJ-b z zn\&d,7-<I40y4,8&`84-8J-4C$Z$@x($4%C$C$C$33 (XC$C$C$y4&&&&^^^^^^^^^JJJJJJ  BLINN COLLEGE LEAVE REQUEST AND ABSENCE REPORT  Blinn College salaried employees should use this form when recording absences. Hourly employees will complete time sheets but may use this form to provide further details. Forward signed forms to the Human Resource Office. This leave form must be sent to the HR office by the employee or supervisor no later than the third day of continuous absence. EMPLOYEE NAME  FORMTEXT   BLINN ID#  FORMTEXT       (Print) Date(s) of Absence:  FORMTEXT   Total Days:  FORMTEXT    FORMTEXT   If half day ( FORMCHECKBOX )am ( FORMCHECKBOX ) pm Reason for Absence:  FORMCHECKBOX  Sick Leave  FORMCHECKBOX  Vacation (In Advance)  FORMCHECKBOX  Personal Leave  FORMCHECKBOX  Civil Leave/Jury Duty  FORMCHECKBOX  Funeral Leave*  FORMCHECKBOX  Leave Without Pay *Immediate Family  FORMCHECKBOX  Worker's Comp** Refer to employee handbook for leave definitions. Details, if necessary:  FORMTEXT    Employee Signature/ Date Supervisor Signature/Date ** 124  @ D j n Ǿ~vf~T~O hY?5#jhI+hI+>*UmHnHujhI+hI+>*UhI+hI+>*jhI+hI+>*Uh?hY?>*mHnHujhY?>*U hY?>*jhY?>*UhI+hY?hY?5OJQJhY?5OJQJhY?6OJQJhY?OJQJ%jhY?OJQJUhmHnHuhY?5CJOJQJ0134   B D l n N `dh`dh@& !@&$a$.vn p    < > ` b ~   & ' 5 6 7 A M N O ] ճըճ՝՘ճՍճՂ՘ճjhY?UjhY?U hY?5j6hY?UjhY?UjhY?Uj$hY?>*UjhY?>*UhY?hY?>*mHnHuj hY?>*U hY?>*jhY?>*U/] ^ _ z {      6 7 h j 豪蠛pjhY?UhmHnHuhI+hY?>*mHnHujhY?>*U hY?>*jhY?>*U hY?56 hY?5jbhY?U hY?CJjhY?UjzhY?UjhY?UhY?jhY?UjhY?U,  6 7 i j .0134679:mdh@& dh@&`dhdh`Requires an election of paid or unpaid leave.     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