CAMDEN FAIRVIEW SCHOOL DISTRICT by GvsmUBG

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									                                           CAMDEN FAIRVIEW SCHOOL DISTRICT
                                              ADMINISTRATOR/SUPERVISOR
                                                         AND
                                                CLASSIFIED EMPLOYEES

Name________________________________________Month____________________________________20__

Social Security #_______________________________

Please record absence information below.

Dates                       Total # Sick                Funeral Vacation        Jury Duty    Professional
                            of days                                                                          Leave__

__________                  ______ _____                _____          ______ ______ _______

__________                  ______ _____                _____          ______ ______ _______

__________                  ______ _____                _____          ______ ______ _______

__________                  ______ _____                _____          ______ ______ _______

__________                  ______ _____                _____          ______ ______ _______

Total Days Absent:          ______ _____                _____          ______ ______ _______

                 FOR SUPERVISOR ONLY
                Additional and/or Missed Hours
                                                                           _______________________________________
Date      # of Hours        Rate of Pay        Amount
                                                                           DATE
_______   _________     X   __________    = _______

_______   _________     X   __________    = _______
                                                                           _______________________________________
                                                                             EMPLOYEE’S SIGNATURE
_______   _________     X __________      = _______

                                                                             _______________________________________

ADMINISTRATOR’S/SUPERVISOR’S SIGNATURE

                                                                            _______________________________________
                                                                            SUPERINTENDENT’S SIGNATURE

*****************************************************************************************

I was not absent during this period.

_____________________________                                               _______________________________________
DATE                                                                        ADMINISTRATOR’S/SUPERVISOR’S SIGNATURE

                                                                            _______________________________________
                                                                            EMPLOYEE’S SIGNATURE

                                                                            _______________________________________
                                                                            SUPERINTENDENT’S SIGNATURE

								
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