"Classified Bargaining Unit Monthly Absence Report Form - Victor Valley College"

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Victor Valley College
CLASSIFIED BARGAINING UNIT MONTHLY ABSENCE REPORT
Name:
SSN last 4 digits XXX-XX- ____________
Dept:
Reporting Month/Year:___________________
* * * SEE EXAMPLES BEFORE COMPLETING THIS FORM * * *
ABSENCE
Examples
Hours
Hours
Hours
Date
Absent/Code
Absent/Code
Absent/Code
(see codes list)
(see codes list)
(see codes list)
AB1
AC1
AB2
AC2
AB3
AC3
01
02
03
04
05
ABSENCE CODES
06
***If the absence code you are selecting has an *, you MUST complete additional information requested below***
07
* (B4) BEREAVEMENT LEAVE - 4 days/under 300 miles
08
Relationship and name of deceased___________________________________ City/State: ____________________
* (B6) BEREAVEMENT LEAVE - 6 days /Out-of-state OR over 300 miles
09
Relationship and name of deceased___________________________________ City/State: ____________________
10
(CW) CONFERENCE/WORKSHOP (Employer paid)
(CU) COMP TIME USE - Must be scheduled.
11
(FH) FLOATING HOLIDAY ANNUAL - Must be taken as a full day. One per fiscal year and does not rollover.
12
(FM) FMLA - Prior HR approval required.
13
(CF) CFRA - Prior HR approval required.
* (IA) INDUSTRIAL ACCIDENT/JOB-INCURRED ILLNESS - Report shall be on file within 24 hrs to the HR office.
14
Original Date of injury/illness: __________
15
* (JD) JURY SERVICE – Jury slips required - If you receive jury fees, submit payment to Fiscal Services.
16
(MA) Medical/Dental appointment(s) -
Personal. (Will deduct from sick leave).
* (ML) MILITARY LEAVE - Proof of military service required. Please check box:
Unpaid
Charge Available Vacation
17
* (P9) PERSONAL NECESSITY - If more than one day & multiple reasons, notate appropriate code, otherwise,
18
Check one - Deducts from available sick leave – up to 9 days per year.
19
__ (P91) Family illness/Appts.
__ (P93) Extra bereavement
__ (P92) Accident involving self/family, personal or property
__ (P94) Court - legal obligation
20
__ (P95) Other* Describe: ______________________________(*Supt/President approval - INITIALS____)
21
(SL) SICK LEAVE - Personal illness & injury (If sick leave is depleted, 50% extended illness leave may be available-contact HR)
22
(UA) UNAUTHORIZED ABSENCE - When a leave bank is exhausted , absence(s) associated with that bank is considered
Unauthorized Absence (UA) and wages will be adjusted accordingly, unless BOT has approved LWOP in advance.
23
* (UB) UNION BUSINESS - Complete Union Business Time Log
24
(VA) VACATION LEAVE - May be taken in units of not less than 15-minute increments. Use of vacation bank must be pre-approved.
25
* (WL) WITNESS LEAVE – Court document required
For complete text, refer to Bargaining Unit Agreement
26
27
______
______________________________
28
Employee Signature
Date
Supervisor Signature
Date
29
-
FOR PAYROLL USE ONLY
ABSENCES
30
Requested leave unavailable, charge _____ hrs to ______ or, Dock wages on ___/___/___ payroll.
Updated
11/25/14
31
Victor Valley College
CLASSIFIED BARGAINING UNIT MONTHLY ABSENCE REPORT
Name:
SSN last 4 digits XXX-XX- ____________
Dept:
Reporting Month/Year:___________________
* * * SEE EXAMPLES BEFORE COMPLETING THIS FORM * * *
ABSENCE
Examples
Hours
Hours
Hours
Date
Absent/Code
Absent/Code
Absent/Code
(see codes list)
(see codes list)
(see codes list)
AB1
AC1
AB2
AC2
AB3
AC3
01
02
03
04
05
ABSENCE CODES
06
***If the absence code you are selecting has an *, you MUST complete additional information requested below***
07
* (B4) BEREAVEMENT LEAVE - 4 days/under 300 miles
08
Relationship and name of deceased___________________________________ City/State: ____________________
* (B6) BEREAVEMENT LEAVE - 6 days /Out-of-state OR over 300 miles
09
Relationship and name of deceased___________________________________ City/State: ____________________
10
(CW) CONFERENCE/WORKSHOP (Employer paid)
(CU) COMP TIME USE - Must be scheduled.
11
(FH) FLOATING HOLIDAY ANNUAL - Must be taken as a full day. One per fiscal year and does not rollover.
12
(FM) FMLA - Prior HR approval required.
13
(CF) CFRA - Prior HR approval required.
* (IA) INDUSTRIAL ACCIDENT/JOB-INCURRED ILLNESS - Report shall be on file within 24 hrs to the HR office.
14
Original Date of injury/illness: __________
15
* (JD) JURY SERVICE – Jury slips required - If you receive jury fees, submit payment to Fiscal Services.
16
(MA) Medical/Dental appointment(s) -
Personal. (Will deduct from sick leave).
* (ML) MILITARY LEAVE - Proof of military service required. Please check box:
Unpaid
Charge Available Vacation
17
* (P9) PERSONAL NECESSITY - If more than one day & multiple reasons, notate appropriate code, otherwise,
18
Check one - Deducts from available sick leave – up to 9 days per year.
19
__ (P91) Family illness/Appts.
__ (P93) Extra bereavement
__ (P92) Accident involving self/family, personal or property
__ (P94) Court - legal obligation
20
__ (P95) Other* Describe: ______________________________(*Supt/President approval - INITIALS____)
21
(SL) SICK LEAVE - Personal illness & injury (If sick leave is depleted, 50% extended illness leave may be available-contact HR)
22
(UA) UNAUTHORIZED ABSENCE - When a leave bank is exhausted , absence(s) associated with that bank is considered
Unauthorized Absence (UA) and wages will be adjusted accordingly, unless BOT has approved LWOP in advance.
23
* (UB) UNION BUSINESS - Complete Union Business Time Log
24
(VA) VACATION LEAVE - May be taken in units of not less than 15-minute increments. Use of vacation bank must be pre-approved.
25
* (WL) WITNESS LEAVE – Court document required
For complete text, refer to Bargaining Unit Agreement
26
27
______
______________________________
28
Employee Signature
Date
Supervisor Signature
Date
29
-
FOR PAYROLL USE ONLY
ABSENCES
30
Requested leave unavailable, charge _____ hrs to ______ or, Dock wages on ___/___/___ payroll.
Updated
11/25/14
31