Human Resources

SUPPLEMENTAL SERVICE REQUEST & VERIFICATION

REQUEST FOR CURRICULUM INSTRUCTION /
STAFF DEVELOPMENT SUPPLEMENTAL SERVICE

EDUCATIONAL SUPPORT PERSONNEL (Classified) STAFF ONLY
(TIME SHEETS MUST ACCOMPANY SUPPLEMENTAL FORM)

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.)

(Please include documentation detailing the dates and hours worked for each employee.)
 

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 Hourly Rate Total Amount
to be Paid
 
 
 
 
 
 
 
 
 
 

Total: 

Count: 


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Print Shop 20-0042      Web Form 20-0042W       Rev. 04/2003