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  • King County Absence Request Form

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    Bill Hodges
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    This document is a King County absence request form containing fields for an employee to provide identification details, specify the type of paid or unpaid absence, reason for absence including illness details, dates of absence, a signature, and approval section. The form provides instructions that it must be completed within 3 business days of the absence and distributed to payroll, the supervisor, and employee.

    Original Description:

    Original Title

    ABSENCE REQUEST FORM

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    This document is a King County absence request form containing fields for an employee to provide identification details, specify the type of paid or unpaid absence, reason for absence including illness details, dates of absence, a signature, and approval section. The form provides instructions that it must be completed within 3 business days of the absence and distributed to payroll, the supervisor, and employee.

    Copyright:

    © All Rights Reserved
    Download as XLS, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    15 views1 page

    King County Absence Request Form

    Uploaded by

    Bill Hodges
    This document is a King County absence request form containing fields for an employee to provide identification details, specify the type of paid or unpaid absence, reason for absence including illness details, dates of absence, a signature, and approval section. The form provides instructions that it must be completed within 3 business days of the absence and distributed to payroll, the supervisor, and employee.

    Copyright:

    © All Rights Reserved
    Download as XLS, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    Department of Executive Services

    King County Absence Request Finance and Business Operations Division


    Payroll Operations Services
    Instructions Below - Original: Payroll Clerk

    1. Identification Data Scroll down to see important instructions at bottom of form

    Name Department KCIT Central

    Classification Division RCS-ITBS

    2. Absence With Pay - Type Bereavement (B) Jury Duty (J)


    City, County, or Federal
    Sick Leave (S) Military Leave (M)
    Vacation (V) Comp Time (T) or Other (O) Explain
    Executive Leave (E)

    3. Absence Without Pay - Type


    Regular Leave of Absence Absence without Leave [Unauthorized]
    (L) (A)
    Educational Leave of Absence Other (F)
    (E) Explain

    4. Reason for Paid or Unpaid Illness Absence (Check all boxes that apply.)
    Serious Health Condition sel family
    Health Care Appointment
    for: f member
    (See definition below. If checked, please contact your supervisor or payroll clerk
    Personal Illness immediately and obtain an FMLA form.)

    Family Sick
    Work Related Illness or Injury
    Leave
    Relationship to employee:
    (Note: A worker's compensation claim must be filed with King County Safety &
    Claims Management and be authorized by a physician for benefits to be paid.)
    Verification of employee's or family member's illness may be required for any illness absence.

    5. Dates of Absence Show number of hours absent each date.

    1 2 3 4 5 6 7 8 9 10 11 12

    13 14 15 16 17 18 19 20 21 22 23 24

    25 26 27 28 29 30 31

    Month / Year April 2010 Total Hours of Absence 0.00

    6. I request approval of my absence form work as indicated above.

    Employee Signature Date April 17, 2023

    7. Approved Verified Date


    Yes No Yes No

    Department Head or Authorized Representative

    Approver: Within 3 business days, you must complete section (7), sign, make two copies and distribute as follows:
    Original - Payroll Clerk Copy - Supervisor Copy - Employee

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