Attendance/Time
Davison Community Schools
Verification Form
Note to employer: Students enrolled in an approved work-based learning program can earn High School credit. State
guidelines require that a record of the student’s attendance on the job is maintained by the school.
It is the student’s responsibility to complete and return this form to the school. Employers must verify the student’s
work hours.
__________________________________________________________________________________________________
Program
Employer
Month/Year
Report Period
From:
Instructions to student:
1. Complete all sections
2. Codes for Total ours
A =Absent (no call) C = Absent (called in) X= Not scheduled
3. This report must be returned to the coordinator within two
two weeks of the last date.
_______________________________________________________________________________________
DATE
IN
OUT
TOTAL HOURS
TASKS PERFOMED
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
SUB TOTAL ________________
_______________________________________________________________________________________
DATE
IN
OUT
TOTAL HOURS
TASKS PERFOMED
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
GRAND TOTAL ________________
I verify that I have worked the above stated hours, times and dates.
Student Signature:
Date:
As the Supervisor, I verify that this student has worked the above stated hours.
Supervisor Signature:
Date:
Please return to:
Davison High School
The student’s work performance for this period is:
1250 N Oak Road
_____ Exceptional
Davison, MI 810-591-0143
_____ Satisfactory
Fax: 810-591-3555
_____ Unsatisfactory, Coordinator please call.