White: Payroll
EMPLOYEE#
Yellow: Instructor
PART-TIME INSTRUCTOR TIME REPORT
NAME:
________________________________________________
TELEPHONE#:
_____________________________
FULL COURSE NUMBER & TITLE:___________________________________________________________________
(i.e. XXX-000-00 / Basic Education)
SCHEDULED DAY AND TIME:______________________________________ # HRS PER DAY:___________________
(i.e. MW - 1:00p-2:20P)
SEMESTER REPORTING PERIOD
Summer/Spring/Fall Month/Year (i.e. Aug 04)
TOTAL HOURS SERVED THIS TIME PERIOD: _______________________________
INDICATE NUMBER OF HOURS OF INSTRUCTION IN EACH BLOCK. IF ABSENT, PLACE LETTER “A” IN BLOCK
Day of Month
123456789101112131415
Number of Hours
of Instruction
Day of Month
16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Number of Hours
of Instruction
Below please briefly state the reason for any absence, i.e., illness, etc.
Employee's Signature: Date:
Authorized Approval: Date:
Date:
DDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDDD
FOR OFFICE USE ONLY
$
PAY PD ADJ CODE JOB CODE INITIALS
TOTAL EARNINGS THIS PERIOD $
All time reports must be submitted by the 10
th
day of each month.
NOTE
: Separate time reports must be submitted for each course. Incomplete time reports will be returned.
I certify that the above is a true and correct statement of the hours served during this period.
TOTAL HOURS RATE OF PAY
Palo Verde College
