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Absence Request Form

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.

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Bill Hodges
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34 views1 page

Absence Request Form

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.

Uploaded by

Bill Hodges
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLS, PDF, TXT or read online on Scribd
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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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