A-BASIS by 9vaq65C

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									                        DIVISION OF SPECIAL EDUCATION
                 CERTIFICATED PAYROLL TIME REPORTING FORM
                                                C-BASIS


      EMPLOYEE NAME: ____________________________                         PAY PERIOD: APRIL 2012

      EMPLOYEE NUMBER: _________________________                           LOCATION CODE:

          Attach mileage reports, vacation, illness and personal necessity cards to this report.
                 Hours     Hours              LOCATION/REMARKS                       INITIAL INITIAL
DAY     DATE
                 Worked Absent (Indicate site/(s) at each day and/or Benefit Used)      IN       OUT

M       4-2-12                                       Spring Recess
 T      4-3-12                                       Spring Recess
W       4-4-12                                       Spring Recess
TH      4-5-12                                       Spring Recess
 F      4-6-12                                         Furlough

M       4-9-12
 T     4-10-12
W      4-11-12
TH     4-12-12
 F     4-13-12

M      4-16-12
 T     4-17-12
W      4-18-12
TH     4-19-12
 F     4-20-12

M      4-23-12
 T     4-24-12
W      4-25-12
TH     4-26-12
 F     4-27-12

M      4-30-12
 T
W
TH
 F

      __________________________________________                           ________________________
      Employee Signature                                                   Date

      __________________________________________                           ________________________
      Administrator’s Signature                                            Date

                         Return to the District Office of Transition Services (DOTS)
                                          Beaudry Bldg., 17th Floor

								
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