Certificated Employee Attendance Report
Supervisor Code: CODES SL PN AL U BT Track Sick Leave (1/4 day increments) Personal Necessity (1/4 day increments) Approved Leave (without pay; PA required) Unassigned Day Banked Time (Management Only) (Teachers Only) I1 * I2 * ML* O Industrial Injury (Original/New Injury) Date of Injury: Industrial Injury 2 (Recurrence/Continuation) of symptoms related to prior injury Maternity Leave Date of original injury * Dr's Statement required Other: Specify - JD=Jury Duty, M=Meeting, B=Bereavement (bereavement relationship) Days Worked
Pay Period
(month / day / year)
Name: Social Security #: Work Location: CDC-R Program
Enter Days Unassigned Worked
Enter Other Days
SL PN AL BT I1 I2 ML O
Name of Substitute
Job Title:
Date 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
I certify that this is a true statement and all required verifications are attached.
Employee's Signature
Supervisor Signature
Rev: 4/17/07
Total
0
0
0
0
0
0
0
0
0
0
0
Rev: 4/17/07