MONTHLY PAYROLL WORKSHEET AND REPORT OF SERVICE

For the month of ____________, 20___

STATION:
DISTRICT/SCHOOL:

SALARY ABSENCES/UNDERTIME DEDUCTIONS

EMPLOYE POSITIO DIVISION
EMPLOYEE NAME CAUSE REMARKS
E NO. N TITLE BASIC ACA/PERA INCLUSIVE DATES Dy/Hr/Min ACTION BASIC ACA/PERA

                       
                       
                       
                       
                       

CERTIFIED CORRECT: APPROVED BY:

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*Additional Columns may be added or may be removed dependent on the number of days the activity will be conducted

* Cells may be merged dependent on the duration of identified activity/session

* Each cell box must contain the title of the specific activity / session and name of person-in-charge or learning facilitators