CALIFORNIA STATE UNIVERSITY, SACRAMENTO
ABSENCE AND EXCESS HOURS WORKED REPORT
NAME: (First, MI, Last)
Pay Period (Month/Year)
Qualifying Non-Qualifying
(see reverse)
Multiple Positions
REVISION
(Replaces ALL previous reports for this pay period)
TIME BASE FT HI
OR
CBID
time base fraction EMPL RCD # FLSA
N E Absences With Pay:
SL SLF SLD FL VA CT0 HT Sick Leave Self Sick Leave Family Family Death … Indicate Relationship ___________ Funeral Leave … Indicate Relationship ___________ Vacation Comp Time Taken Holiday Credit Taken
Refer to instructions to complete this report. Shift Pay:
PH ML MPA JD EP EM UTN UTR SW01 Using Personal Holiday Short-term Military Leave (In Days) Attach Military Duty Orders Maternity / Paternity / Adoption Leave Jury Duty (Attach two history reports) Excess Hours Earned Using Excess Hrs Credit Union Time Taken - Not Reimb. Union Time Taken - Reimb Subpoenaed Witness (DON'T KEY IN CMS) SHGRV SHSWG SHE08 SHN08 SHIFT NIGHT SHIFT EVENING SHIFT EVENING - R08 SHIFT NIGHT - R08
Absences Without Pay (DO NOT KEY IN CMS):
A DOCK Absence Without Leave (AWOL - Unapproved Absence) Informal Leave Without Pay Granted (14 working days or less) NOTE: FORMAL LEAVE OF 15 DAYS OR LONGER REQUIRES A FORMAL APPROVAL AND IS NOT REPORTED ON THIS ABSENCES REPORT.
Irregular Work Schedule - Excess Hours Calculation (Applicable to Non-Exempt Only)
(22 day pp = 176 hrs.; 21 day pp = 168 hrs.)
HRS X timebase =
0
Actual Scheduled Hours
=
Include all dates in pay period - see State Pay Period Schedule. Employees working irregular work week must indicate daily work schedule below
Pay Period Irregular/ REG
1
2
3
4
5
6
7
8
9
10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29
30
31 Total Hours 0.0
SL SLF SLD FL VA CTO HT PH ML MPA JD EP EM UTN UTR
SL SLF SLD FL VA CTO HT PH ML MPA JD EP EM UTN UTR SW01 A DOCK
SHGRV SHSWG
0.0 0.0 0.0 0.0
0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0
SW01 - NO ENTRY A - NO ENTRY DOCK - NO ENTRY SHGRV SHSWG SHE08 SHN08 HOL
0.0 0.0 0.0 0.0 0.0
SHE08 SHN08
HOL HI HRLY Wage Rate: $
To the best of my knowledge and belief, the facts stated are accurate and in full compliance with legal requirements. I understand substantiation shall be required for sick leave in accordance with current Bargaining Unit Contracts and/or CSU Policies.
TOTAL H.I. PAID HRS. (Includes paid leave hrs.)>
I approve the use and/or earning of leave benefits as indicated above. I understand substantiation shall be required and attached for sick leave in accordance with current Bargaining Unit Contracts and/or CSU Policies.
Keyed Approved
6/24/2003 Employee's Signature Date
85888 Campus Phone
Supervisor Signature Date Campus Phone
Payroll Use Only
CMS PR54 (Rev 3/21/03)