ADMINISTRATIVE OFFICE OF COURTS
EMPLOYEE ATTENDANCE RECORD
NAME:
MONTH/YEAR:
JOB TITLE:
PHONE NUMBER:
Social Security Number:
TOTALS
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PERSONAL LEAVE
MAJOR MEDICAL LEAVE
MAJ. MED. (DEATH IN FAMILY) RELATION:
RELATION:____________________________________
HOLIDAY LEAVE
NATURAL DIASTER LEAVE (HURRICANE, SNOW, ETC.)
EDUCATIONAL DAY
MILITARY LEAVE (ORDERS ATTACHED)
CIVIL LEAVE (COURT ORDERS ATTACHED)
LEAVE WITHOUT PAY (ONLY IF LEAVE IS NOT AVAIL.)
ROUTINE HOURS WORKED
HOLIDAY WORKED
TOTALS:
I certify these leave records to be true and correct.
Date signed:
(Signature of Employee)
I certify these leave records to be accurate to the best of my knowledge.
Date signed:
(Signature of Supervisor)
NOTE: Both rows and columns ARE REQUIRED to be totalled.
As a cross-check, the total of the first column and the bottom row (bottom left shaded total) should be the same.
Days during each month that represent week-ends should be highlighted with a marker or "X'ed" out.
Time sheets are due to the Finance Department on or before the 5th of each month.
If these forms are not received by the due date we will stop any direct deposits and hold any checks for the month.
Revised 7/13/99