ABCDEFGHIJKLMNOPQRSTUVACADAE
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ORGANIZATION NAME
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Employee:
Approved By:
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Title: Title: Month:
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Date: Date: Year:
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Approval
Approval
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1I affirm that this is a true and complete representation of my time worked for each program.2I affirm that I have reviewed this record for accuracy and completeness.
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TIME ALLOCATIONS - ACTUAL HOURS WORKED IN .25 HOUR INCREMENTSL E A V E S T A T U S
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DATEFUNDING SOURCE 1FUNDING SOURCE 2FUNDING SOURCE 3FUNDING SOURCE 4FUNDING SOURCE 5FUNDING SOURCE 6FUNDING SOURCE 7FUNDING SOURCE 8FUNDING SOURCE 9FUNDING SOURCE 10FUNDING SOURCE 11FUNDING SOURCE 12Other*PCHJTOTAL HRSCOMP OTW/O PAYEXPLANATION*
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10.00
12
20.00
13
30.00
14
40.00
15
50.00
16
60.00
17
70.00
18
80.00
19
90.00
20
100.00
21
110.00
22
120.00
23
130.00
24
140.00
25
150.00
26
160.00
27
170.00
28
180.00
29
190.00
30
200.00
31
210.00
32
220.00
33
230.00
34
240.00
35
250.00
36
260.00
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270.00
38
280.00
39
290.00
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300.00
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310.00
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0.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.000.00
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Leave status:
P - Paid Time Off
H - Holiday Leave
Comp Time from Previous Month
0.00
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C - Compensatory Leave
Earned Comp Time
0.00
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J - Jury or Civil Leave
Used Comp Time
0.00
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Balance at Month End
0.00
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50
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53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100