Fillable LOCATION: CCC DIST DVC LMC Substitute (Hourly) for (Los Medanos College)

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LOCATION: CCC DIST DVC LMC Substitute (Hourly) for (Los Medanos College)

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7117
Certified Employee Variable Service Report-Teaching Services
Print NAME (last name first)
EMPLOYEE ID NUMBER
MONTH/YEAR
LOCATION: CCC DIST DVC LMC
SERVICE PERFORMED:
Substitute (Hourly) for
Substitute (Daily) for
(last name first)
Special Program Instructor (Hourly)
COURSE INFORMATION: Title/No.
Section
Days
TIME SERVED:
MONTH
Position Number
1
2
3
4
5
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8
9
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11
12
13
14
15
16
17
18
19
20
21
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23
24
25
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30
31
TOTAL
(Absence Codes: A-Absent without pay, S-Sick, P-Personal necessity leave, H-Paid Holiday, B-Bereavement leave, I-Industrial Accident or Illness)
Employee Signature
DATE
Contra Costa Community College District
Signature of SUPERVISOR
DATE
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LOCATION: CCC DIST DVC LMC Substitute (Hourly) for (Los Medanos College)

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Completed 2 February 2021

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