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FACTER, JeffreyName of EmployeeAddressAddressPhone NumberPosition TitlaPosition Number Level StepOFFICE OF THE CLERKU.S. HOUSE OF REPRESENTATIVESPERSONAL LEAVE RECORD1978YEARDATE OF APPOINTMENT12-30-76ANNUAL LEAVE CATEGORY1.01.52.0BALANCE BROUGHT FORWARD FROM PRECEDING YEAR| Annual Leave | Sick Leave || ------------ | ---------- || 6            | 12         |PRIOR FEDERAL SERVICE| Years | Months || ----- | ------ || 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.  |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     | 1   |     || Feb.  |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     | X   | X   | X   | X   |     |     |     |     |     | X   | X   | X   | X   |     | 1   || Mar.  |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     | X   | X   | X   | X   | X   | X   | X   | X   |     | 1   |     |     || Apr.  |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     || May   |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     || June  |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     || July  |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     || Aug.  |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     || Sept. |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     || Oct.  |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     || Nov.  |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     || Dec.  |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     |     || ACCRUED THIS MONTH | AVAILABLE THIS MONTH | USED THIS MONTH | BALANCE AT CLOSE OF MONTH | EMPLOYEE INITIALS |            |              |            |     || ------------------ | -------------------- | --------------- | ------------------------- | ----------------- | ---------- | ------------ | ---------- | --- || Annual Leave       | Sick Leave           | Annual Leave    | Sick Leave                | Annual Leave      | Sick Leave | Annual Leave | Sick Leave |     || 1                  | 1                    |                 |                           |                   |            | 7            | 13         |     || 1                  | 1                    |                 |                           |                   |            | 8            | 14         |     || 1                  | 1                    | 9               | 15                        | 9                 |            | 0            | 15         |     |= 0.5 day annual leave= 1.0 day annual leave= 0.5 day sick leaveS or S = 1.0 day sick leaveA = 0.5 day administrative leaveA or A = 1.0 day administrative leave= 0.5 day unauthorized absenceU or U = 1.0 day unauthorized absence= 0.5 day leave without pay= 1.0 day leave without payEmployee's Signature Date(If employee refuses to sign, state reason below.)CERTIFIED CORRECT:Chief's Signature DateApproved: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