Spreadsheet: 00286256-1269-4cc6-a19f-f04c89a17dc5
Sheet: Sheet1

Unnamed: 0 | Unnamed: 1 | Unnamed: 2 | EMPLOYEE ATTENDANCE REPORT | Unnamed: 4 | Unnamed: 5 | Unnamed: 6 | Unnamed: 7 | Unnamed: 8 | Unnamed: 9 | Unnamed: 10 | Unnamed: 11 | Unnamed: 12 | Unnamed: 13 | Unnamed: 14 | Unnamed: 15 | Unnamed: 16 | Unnamed: 17 | Unnamed: 18 | Unnamed: 19 | Unnamed: 20 | Unnamed: 21 | Unnamed: 22 | Unnamed: 23 | Unnamed: 24 | Unnamed: 25 | Name of empoyee (last, first, middle) | Unnamed: 27 | Unnamed: 28 | Unnamed: 29 | Unnamed: 30 | Unnamed: 31 | Unnamed: 32 | Unnamed: 33 | Unnamed: 34 | Unnamed: 35 | Unnamed: 36 | Unnamed: 37 | Unnamed: 38 | Unnamed: 39
 |  |  | State Form 14304 (R4 / 12-99) |  |  |  |  |  |  |  | A-4
 |  |  | Approved by State Board of Accounts 1997 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Employee number
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Classification Title
INSTRUCTIONS
1. | This form must be completed by each employee and approved by the immediate |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Agency / Division / Section / Unit
 | supervisor (except where use of an alternate attendance report has been approved
 | by the State Board of Accounts).
2. | Enter number of hours rounded to the nearest quarter hour (15 minutes = .25; |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Account
 | 30 minutes = .50; 45 minutes = .75; 60 minutes = 1.00).
3. | On the day that holidays are observed, enter in the Holiday box the number of hours
 | you would normally have been scheduled to work. If you worked the holiday, also |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Bi-weekly pay period
 | enter in the Other Compensable Hours worked box, all hours actually worked. |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Sunday, |  |  |  |  |  | through Saturday,
4. | All overtime must be pre-approved.  For payable overtime, you will only be paid
 | the overtime if total hours for the week meet overtime requirements.
5. | Working hours in excess of the minimum required does not entitle an overtime exempt employee to overtime pay or compensatory time off unless special
 | authorization has been received for this pay period. Special overtime pay authorization should be explained in the comments section. Compensatory time
 | accrued or used by exempt employees should also be recorded on the Compensatory Time Worksheet.
6. | If an absence is covered by the Family and Medical [NAME], enter the hours of absence in the appropriate Paid or [NAME] box AND in the Family
 | and Medical Leave box.
7. | Total regular hours should equal bi-weekly schedule (for example 75.00).  This includes regular hours worked, holiday pay, vacation,
 | sick, personal, compensatory and other leave hours.
TIME ENTRY
[NAME] |  |  |  | S |  | M |  | T |  | W |  | T |  |  | F |  | S |  | S |  |  | M |  |  | T |  | W |  | T |  | F |  | S |  | TOTAL HOURS
Regular
Hours worked
Other Compensable
Hours worked
Holiday |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0
Vacation leave |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0
Sick leave |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0
Personal Leave |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0
Compensatory |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0
leave used
Funeral leave |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0
Military leave |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0
Jury duty |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0
Leave without |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0
pay
Other Leave |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0
(specify below)
Family and |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 0
Medical Leave
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Total Regular Hours
Overtime Summary to be completed by payroll clerk
Week1: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Week2:
 |  | Regular Overtime |  |  |  |  |  |  | Premium Overtime |  |  |  |  |  |  |  |  |  | Regular Overtime |  |  |  |  |  |  |  |  | Premium Overtime
 | Total Compensatory Hours Accrued This Pay Period: |  |  |  |  |  |  |  |  |  |  |  |  |  | Regular |  |  |  |  |  |  |  | + ( |  |  |  | Premium x 1.5) =
 | Total Other Hours Payable This Pay Period: |  |  |  |  |  |  |  |  |  |  |  |  |  | Regular |  |  |  |  |  |  |  | + ( |  |  |  | Premium x 1.5) =
Conversion of Regular 7.5 Days to Total Hours
Days |  | 10.0 | 9.5 |  | 9 |  | 8.5 |  | 8.0 |  | 7.5 |  | 7 |  |  | 6.5 |  | 6 |  | 5.5 |  |  | 5.0 |  |  | 4.5 |  | 4.0 |  | 3.5 |  | 3.0 |  | 2.5 | 2.0 |  | 1.5 | 1 | 0.5
Hours |  | 75.00 | 71.25 |  | 67.5 |  | 63.75 |  | 60.00 |  | 56.25 |  | 52.5 |  |  | 48.75 |  | 45 |  | 41.25 |  |  | 37.50 |  |  | 33.75 |  | 30.00 |  | 26.25 |  | 22.50 |  | 18.75 | 15.00 |  | 11.25 | 7.5 | 3.75
Comments
I certify this report is correct.
Signature of employee (claimant) |  |  |  |  |  |  |  |  |  |  |  | Date signed |  |  |  |  |  |  | Approved by: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Date signed
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  | See additional information on back of form |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | See attachments