DIVISION OF SPECIAL EDUCATION
CERTIFICATED PAYROLL TIME REPORTING FORM
C-BASIS (SINGLE-TRACK)
EMPLOYEE NAME: ____________________________ PAY PERIOD: JUNE 2011
EMPLOYEE NUMBER: _________________________ LOCATION CODE:
Please attach mileage reports, vacation, illness and personal necessity cards to this report.
INITIAL INITIAL
DAY DATE HRS ABS LOCATION/REMARKS
IN OUT
M
T
W 6-1-11
TH 6-2-11
F 6-3-11
M 6-6-11
T 6-7-11
W 6-8-11
TH 6-9-11
F 6-10-11
M 6-13-11
T 6-14-11
W 6-15-11
TH 6-16-11
F 6-17-11
M 6-20-11
T 6-21-11
W 6-22-11
TH 6-23-11
F 6-24-11
M 6-27-11 HOLIDAY
T 6-28-11 Furlough
W 6-29-11 Unassigned
TH 6-30-11 Unassigned
F
__________________________________________ ________________________
Employee Signature Date
__________________________________________ ________________________
Administrator’s Signature Date
Return to the District Office of Transition Services
Beaudry Bldg., 17th Floor