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A-112

Jul-05

SALARIED EXEMPT PERSONNEL ACTIVITY REPORT

Employee:

_______________________________________________________

ID #

__________

Pay Period:

___________________________

to __________________________

Position/Location:

____________________________________________________________________

Allocation of Time:

_________

% Head Start

__________

% Early Head Start

WORK CODES

Date

Administration

Nutrition

Education

Health/ Disabilities

Family Service

MIS

Other

Leave Code

Sun

Mon

Tues

Wed

Thur

Fri

Sat

Sun

Mon

Tues

Wed

Thur

Fri

Sat

YES

Leave Codes: H - Holiday S - Sick Leave V - Vacation

  • O

    - Other

Supervisor Comments:

Employee Signature and Date

Supervisor Signature and Date

A112_TimesA11t2__STilmesh_eet_eSalaried_Exempt VERSION 1.forms@kci 09223372036854764623,9223372036854764624

9

2009

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