Human Resources

SUPPLEMENTAL SERVICE REQUEST & VERIFICATION

REQUEST FOR CURRICULUM INSTRUCTION /
STAFF DEVELOPMENT SUPPLEMENTAL SERVICE

CERTIFICATED STAFF ONLY

Start Date:  

End Date:  

Pay Type Code:
           
Service Requested: (Describe the work to be completed; describe time period for the service and other conditions which must be met.)

Note: Form default rate is extracurricular rate; if activity calls for a different rate, input that rate - form will auto calculate.

SUBMIT FOR PAYMENT OF COMPLETED SERVICE

NOTE:
Forms received in the Human Resources office after the 10th of the month will be paid in the next monthly warrant.

Name Loc # ID # Budget # For All Lines
LOC PROG AC OBJ
Hours
(enter 1 if stipend)
Hourly Rate
($27.00000)
Total Amount
to be Paid
 
 
 
 
 
 
 
 
 

Total: 

Count: 


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