Classified Employees Monthly Timesheet
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2CHABOTLAS POSITAS COMMUNITY COLLEGE DISTRICT
CLASSIFIED EMPLOYEES MONTHLY TIME AND SERVICE REPORT
EMPLOYEE NAME _______________________________________SS#_________________________ Mo/Yr_______to Mo/Yr_______
READ INSTRUCTIONS ON BACK BEFORE COMPLETING THIS FORM
List any hours of absence for each working day:
HOURS ABSENCE
HOURS ABSENCE
ABSENCE CODE:
DATE ABSENT CODE DATE ABSENT CODE
16
1
Indicate in column marked "Absence Code"
the correct letter.
17
2
S
Illness or injury
18
3
SC
Onthejob injury
E
Personal Necessity Leave**
19
4
B
Bereavement Leave**
C
Required Jury Duty/Court Appearance**
20
5
M
Military Leave**
A
Authorized Board Absence #
21
6
V
Vacation
H
Holiday
22
7
FH
Floating Holiday**
W
Leave Without Pay**
23
8
U
Unauthorized Leave Without Pay
R
Release Time
24
9
__________________________________________
25
10
#
Advance approval of manager is required
**
Advance "Request For Leave of Absence"
26
11
Form is required except in emergencies/bereavement
27
12
__________________________________________
28
13
PLEASE CHECK SERVICE ASSIGNMENT
29
14
Chabot_______ Las Positas_______
30
15
DISTRICT:
Hayward
Livermore
Pleasanton
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MEDICAL STATEMENT: A unit member who claims sick leave for three (3) or more consecutive days or five (5) cumulative days within
any thirty (30) calendar day period, or if the District has reason to believe that the unit member is not legitimately entitled to claim sick
leave may be required to present a written, signed statement on a Districtapproved form from a medical doctor, or from the unit member's
religious advisor where such is deemed in conformance with religious tenets, verifying the nature of the illness, injury or quarantine,
inclusive dates when the employee is unable to work because of medical condition and the date the employee can return to work. A similar
statement may be required by the District in any cases where an absence claimed to be due to illness or injury must be verified. Employees
returning to work after serious illness may be required to provide medical evidence of recovery sufficient to assume regular duties.
I certify this to be a true and accurate record of hours worked.
Employee signature__________________________________________________________________ Date___________________
Manager/Supervisor signature__________________________________________________________ Date___________________
Comments:________________________________________________________________________________________________
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