[180-10060-10475.pdf — page 2]
# OFFICE OF THE CLERK## U.S. HOUSE OF REPRESENTATIVES# PERSONAL LEAVE RECORD## 1977**Name of Employee** MARTIN P.W.**Address****Address****Phone Number****Position Title****Position Number** **Level** **Step** **Date of Appointment** 11-8-76 **Annual Leave Category****Prior Federal Service****Balance Brought Forward From Preceding Year**Annual Leave 2 Sick Leave 2Years Months 1.01.52.0| Month | 1   | 2   | 3   | 4   | 5   | 6   | 7   | 8   | 9   | 10  | 11  | 12  | 13  | 14  | 15  | 16  | 17  | 18  | 19  | 20  | 21  | 22  | 23  | 24  | 25  | 26  | 27  | 28  | 29  | 30  | 31  |                |                |              |                 |                |                |               || ----- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | -------------- | -------------- | ------------ | --------------- | -------------- | -------------- | ------------- || Jan.  |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     | Annual Leave 1 | Sick Leave 1   | Annual Leave | Sick Leave      | Annual Leave 3 | Sick Leave 3   |               || Feb.  |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     | Annual Leave 1 | Sick Leave 1   | Annual Leave | Sick Leave      | Annual Leave 4 | Sick Leave 4   |               || Mar.  |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     | Annual Leave 1 | Sick Leave 1   | Annual Leave | Sick Leave      | Annual Leave 5 | Sick Leave 5   |               || Apr.  |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     | Annual Leave 1 | Sick Leave 1   | Annual Leave | Sick Leave      | Annual Leave 6 | Sick Leave 6   |               || May   |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     | Annual Leave 1 | Sick Leave 1   | Annual Leave | Sick Leave      | Annual Leave 7 | Sick Leave 7   |               || June  |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     | Annual Leave 1 | Sick Leave 1   | Annual Leave | Sick Leave      | Annual Leave 8 | Sick Leave 8   |               || July  |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     | Annual Leave 1 | Sick Leave 1   | Annual Leave | Sick Leave      | Annual Leave 9 | Sick Leave 9   |               || Aug.  |     |     |     |     |     |     |     |     |     |     |     |     |     |     | X   | X   | X   |     |     | X   | X   | X   |     |     |     |     |     |     |     |     |     |                | Annual Leave 1 | Sick Leave 1 | Annual Leave 10 | Sick Leave 10  | Annual Leave 0 | Sick Leave 10 || Sept. |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     | X   |     |     |     |     |                | Annual Leave 1 | Sick Leave 1 | Annual Leave 11 | Sick Leave 11  | Annual Leave 0 | Sick Leave 11 || Oct.  |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     | Annual Leave 1 | Sick Leave 1   | Annual Leave | Sick Leave      | Annual Leave   | Sick Leave     |               || Nov.  |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     | Annual Leave   | Sick Leave     | Annual Leave | Sick Leave      | Annual Leave   | Sick Leave     |               || Dec.  |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     | Annual Leave   | Sick Leave     | Annual Leave | Sick Leave      | Annual Leave   | Sick Leave     |               |**Accrued This Month** **Available This Month** **Used This Month** **Balance at Close of Month** **Employee Initials**Terminated 9/30/770.  5 day annual leave1.  0 day annual leave2.  5 day sick leave3.  0 day sick leave4.  5 day administrative leave5.  0 day administrative leave6.  5 day unauthorized absence7.  0 day unauthorized absence8.  5 day leave without pay9.  0 day leave without payCERTIFIED CORRECT:Employee's Signature Date (If employee refuses to sign, state reason below.)Chief's Signature DateAppro.ed: Clerk of the House DateThis record will be forwarded to the Clerk of the House at the end of each calendar year, or in case of termination, along with the request for termination. Upon approval, the record will be filed in the employee's official personnel folder.EXHIBIT I.