The Arkansas Record of Absence — Self-Certification Form is an essential document used in Arkansas to record and certify an individual's absence from work or school for various reasons. This form enables individuals to provide an official record of their absence when they cannot obtain a doctor's note or official documentation. Key Elements of the Arkansas Record of Absence — Self-Certification Form: 1. Purpose: The primary purpose of this form is to establish a formal record of an individual's absence, outlining the specific dates and reasons for their time away from work or school. 2. Employee/Student Information: The form includes sections where individuals can provide their personal details, including name, employee/student ID, department/class, contact information, and their immediate supervisor/teacher's details. 3. Dates of Absence: The form prompts the individual to specify the start and end dates of their absence, ensuring accurate recording of the period they were away. 4. Reason for Absence: There is a section to choose from various pre-defined options to indicate the reason for the absence, such as illness, personal leave, family emergency, bereavement, court appearance, military duty, or other valid reasons. 5. Certification Statement: The form includes a declaration that the information provided is true and correct to the best of the individual's knowledge. By signing the form, the employee or student acknowledges that they understand the consequences of providing false information. Different Types of Arkansas Record of Absence — Self-Certification Forms: 1. Arkansas Work Absence Self-Certification Form: This form is used specifically by employees to certify their absence from work. 2. Arkansas School Absence Self-Certification Form: This form is utilized by students to document their absence from school. 3. Arkansas Family and Medical Leave Act (FMLA) Absence Self-Certification Form: This variant of the form is used by employees who need to take leave under the provisions of the Family and Medical Leave Act. It allows individuals to self-certify their need for leave due to their own or a family member's serious health condition, birth of a child, adoption, or to care for a covered military service member. 4. Arkansas Emergency Leave Self-Certification Form: This particular form is designed for employees or students who need to request emergency leave due to unforeseen circumstances or urgent situations. It enables individuals to self-certify their absence with appropriate explanation and documentation if required. In summary, the Arkansas Record of Absence — Self-Certification Form is a crucial document for individuals in Arkansas to record and validate their absence from work or school. Its purpose is to establish an accurate and official record of the absence, with different types available depending on the specific circumstances and reasons for the absence.
Para su conveniencia, debajo del texto en español le brindamos la versión completa de este formulario en inglés. For your convenience, the complete English version of this form is attached below the Spanish version.