Los Angeles Community College District
FACULTY ABSENCE REPORT
Partial Day (Fractional Day)
(Salaried, Full-Time and Adjunct)
Location:
Employee Name:
Department:
Employee No.
Instructions:
Complete this form and a Absence Certification Request (TA-1). Submit both forms to department
supervisor for acknowledgement and routing to College Time Reporting Office.
Absence
Total Duty Hours
Scheduled
Assignment
Example:
Reason
Illness
Hours
3.00
(Include Office Hours)
6.00
% of
Day
Absent
50%
Remarks:
I certify the absence report noted above.
Employee's Signature and Date
Supervisor's Signature and Date
LACCD Form W-210A 11/08/07
Date
09/07/07
College
LATTC