[Type here] [Type here] Revised 02/2019
Garvey School District
Rosemead, California
0BTIME RECORD CERTIFICATED EXTRA ASSIGNMENT
EMPLOYEE:
Please Print
EMPLOYEE I.D.#
PAYROLL PERIOD:
Month/Year
*Commonly used account numbers but not limited to: Teacher 1170
Psychologist/Counselors/Nurses/Pathologists: 1270
Other Certificated: 1970
1BDate
2BSchool/Department
3BReason for Assignment
4BHour(s)
*Labor Distribution Account
Administrator’s
Initial
5BTOTAL HOURS(S) WORKED
I certify that I have worked the day(s) and location(s), as indicated above.
(SIGNATURE MUST BE IN COLOR OF INK OTHER THAN BLACK)
EMPLOYEE: _________________________________________________ PROGRAM ADMINISTRATOR:
Signature Date Signature Date
Please check with the School Office Manager for the date that your Time Record is due to the Human Resources Office. Late Time Records will be paid the following month.
Time Records will be returned if the above columns are not completely filled in. NO EXCEPTIONS.
Hourly Rate: $36.77