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									                                  UNIVERSITY OF CALIFORNIA                      PREMIUM OVERTIME STATUS
                                       SAN FRANCISCO                                          ELIGIBLE         NOT ELIGIBLE

                                           TIME RECORD                       W ORK W EEK:       STD:           OTHER
      NAME
                                                                                          STD:
                                                                             W ORK SCHEDULE:                   OTHER
      PERIOD COVERED

        1   2   3             4     5   6    7                8       9       10       11
       FUND SOURCE                EXCEPTIONS
                                                           OTHER                      LEAVE
DAY                      HOURS HOLIDA      VACA-           LEAVE     COMP.   OVER-    WITHO
OF                                  Y      TION     SICK   (NOTE      TIME    TIME      UT             EXCEPTIONS CODE
                                   LEAVE   LEAVE   LEAVE     TYPE)    OFF    WORKED    PAY
MO.                           √                                                                      C    -    Comp. time off
                                                                                                     H    -    Holiday
                                                                                                     L    -    leave without pay
                                                                                                     O    -    Overtime
                                                                                                     S    -    Sick leave
                                                                                                     V    -    Vacation
                                                                                                     OL   -    Other leave (note type)
                                                                                                          SUMMARY
 17                                                                                                  DEPARTMENTAL USE
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  1
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  5                                                                                           PREV.                      NEW
  6                                                                                           BALANCE          EARN USAGEBALANCE
  7                                                                                           CT
  8
  9
 10                                                                                           VL
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 13                                                                                           SL
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 16                                                                                           SUMMARY TOTALS
                                                                                              REG.     PAID    REG.    PREM.   COMP.
                              0     0       0        0        0       0        0        0     TIME     LEAVE   O.T.    O.T.    TIME USED


                                    APPROVAL(S)
      I CERTIFY THE ABOVE TIME IS CORRECT



      EMPLOYEE SIGNATURE                           (TITLE)                            (TITLE)                          (TITLE)
      71455-142 - REV. 5/79

								
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