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Employee Name: |
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Position: |
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Start Date of pay Period: |
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End Date of Pay Period: |
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Sat/ |
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Sun |
Mon |
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Wed |
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Working Hours |
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ML, EL, or AD* |
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Holiday |
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Annual Leave |
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Vacation |
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Sick |
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Hospital |
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Bereave- ment |
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Total Hours: |
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Combined: |
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Sat/ |
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Thu |
Fri |
Sun |
Mon |
Tue |
Wed |
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Working Hours |
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ML, EL, or AD* |
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Holiday |
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Annual Leave |
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Vacation |
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Sick |
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Hospital |
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Bereave- ment |
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Total Hours: |
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Combined: |
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Overall: |
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| PERSONNEL ACTIVITY REPORT |
| (Check All That Apply) |
| Teacher Duties in HS Classroom |
| Assisted in HS Classroom |
| Teacher Duties in EHS Classroom |
| Assisted in EHS Classroom |
| Teacher duties in Child Care Classroom |
| Teacher duties in Child Care Classroom |
| Teacher Duties in HS Home Base |
| Teacher Duties in EHS Home Base |
| Drove Bus |
| Monitored on Bus |
| Cook Duties |
| Assisted Parents/Recruitment |
| Assisted Staff |
| Attended Meeting(s)/Training |
| Community Engagement Activities |
| Computer Work, Technology |
| Phone Calls, E-Mails |
| Planning, Budgeting, Grant Writing |
| Purchased Supplies |
| Reporting |
| Hiring |
| Reviewed Staff’s Work/Documents |
| Trained Staff |
| Vision & Hearing |
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| Substitutes – will use any of the first five options applicable to the days worked, after one is checked, please write down the dates you subbed for in that position. |
| One-On-One Aides – check either Assisted in HS or Assisted in EHS Classrooms. |
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| By checking this box, I certify that all information on this form is correct. This checkbox represents my digital signature. |
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| Supervisor’s Signature: |
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| ________________________________________________________ |
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| Date: _____________________________ |
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| Download PDF |
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