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EMPLOYEE ABSENTEE REPORT

Date Time Received

Name

Address

Department Position

Probable Number of Days Absent Return Date

Report Taken By

Reported By Reported By Reason


Spouse [ ] Phone [ ] Illness [ ]
Other Relative [ ] Wire [ ] Injury [ ]
Self [ ] Letter [ ] Family Business [ ]
Friend [ ] Family Death [ ]
Immediate Superior [ ] Transportation [ ]
Jury Duty [ ]
Military Duty [ ]
Other (Specify) [ ]

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