"Leave Activity Reporting Form"

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Leave activity reporting form – Faculty Use Only
COMPANY NUMBER
EMPLOYEE NUMBER
FIRST NAME
M.I.
LAST NAME
LEAVE
COMPANY USE/ INITIALS & DATE
HOURS
DATE FROM
DATE TO
TYPE*
.
.
.
.
.
.
TOTAL >
(ADD HOURS AND ENTER THE TOTAL)
.
LEAVE
COMPANY USE/
PART IV LEAVE TYPES
HOURS
EARNED DATE
TYPE*
INITIALS & DATE
CS = SCH ASST/ VOL SERVICE LEAVE TAKEN
SP
= SICK TAKEN PERSONAL
.
SF
= SICK TAKEN FAMILY (NON-VSDP)
CT
= COMPENSATORY LEAVE TAKEN
ET
= EDUCATION LEAVE TAKEN
MT
= MILITARY LEAVE TAKEN
.
JT
= CIVIL/WORK-RELATED LEAVE
WT
= WORKERS COMPENSATION
XX
= LEAVE WITHOUT PAY
OT = OTHER LEAVE
.
DC
= DISABILITY CREDIT TAKEN
TOTAL >
(ADD HOURS AND ENTER THE TOTAL)
.
FP
= FAMILY PERSONAL TAKEN
SD
= SHORT TERM DISABILITY LEAVE
RT
= RECOGNITION LEAVE TAKEN
EMPLOYEE SIGNATURE (FULL NAME)
DATE
SUPERVISOR’S SIGNATURE
DATE
DEPARTMENT/SECTION
KEYED BY
DATE
BY SIGNING ABOVE WE CERTIFY THAT THE INFORMATION ON THIS FORM IS ACCURATE AND COMPLETE
Leave activity reporting form – Faculty Use Only
COMPANY NUMBER
EMPLOYEE NUMBER
FIRST NAME
M.I.
LAST NAME
LEAVE
COMPANY USE/ INITIALS & DATE
HOURS
DATE FROM
DATE TO
TYPE*
.
.
.
.
.
.
TOTAL >
(ADD HOURS AND ENTER THE TOTAL)
.
LEAVE
COMPANY USE/
PART IV LEAVE TYPES
HOURS
EARNED DATE
TYPE*
INITIALS & DATE
CS = SCH ASST/ VOL SERVICE LEAVE TAKEN
SP
= SICK TAKEN PERSONAL
.
SF
= SICK TAKEN FAMILY (NON-VSDP)
CT
= COMPENSATORY LEAVE TAKEN
ET
= EDUCATION LEAVE TAKEN
MT
= MILITARY LEAVE TAKEN
.
JT
= CIVIL/WORK-RELATED LEAVE
WT
= WORKERS COMPENSATION
XX
= LEAVE WITHOUT PAY
OT = OTHER LEAVE
.
DC
= DISABILITY CREDIT TAKEN
TOTAL >
(ADD HOURS AND ENTER THE TOTAL)
.
FP
= FAMILY PERSONAL TAKEN
SD
= SHORT TERM DISABILITY LEAVE
RT
= RECOGNITION LEAVE TAKEN
EMPLOYEE SIGNATURE (FULL NAME)
DATE
SUPERVISOR’S SIGNATURE
DATE
DEPARTMENT/SECTION
KEYED BY
DATE
BY SIGNING ABOVE WE CERTIFY THAT THE INFORMATION ON THIS FORM IS ACCURATE AND COMPLETE