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Employee Absence Record

(year)

Name

Employee Number

Address

Telephone (

City

State

Social Security Number

Date of Employment

Department

Position

)
Zip

Instructions: Enter the date(s) of excused and unexcused absences, with the appropriate codes. Use this form
to determine when vacation time and sick leave has been earned and used. This record makes it easy to review
the employee's absence record with just a glance. Use black for excused and red for unexcused.
Codes: V = Vacation, T = Tardy, U = Unexcused absence, S = Sick Leave, D = Death in Family, J = Jury Duty,
P = Partial Day, I = Illness in Family, _____ = _______________, _____ = _______________.

January
Date(s)

February
Code Date(s)

Code

April
Date(s)

Code Date(s)

Code

Code Date(s)

Code

Code

Date(s)

Date(s)

Code Date(s)

Code

Code Date(s)

Code

Form 1006, Printed by:

Code

Date(s)

Code Date(s)

Code

Date(s)

Code Date(s)

Code

Date(s)

Code Date(s)

Code

Code

Date(s)

Code Date(s)

Code

September

November
Code Date(s)

Date(s)

June

August

October
Date(s)

March
Code Date(s)

May

July
Date(s)

Date(s)

December
Code Date(s)

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