STATE OF CALIFORNIA - DEPARTMENT OF HUMAN RESOURCES
ABSENCE AND ADDITIONAL TIME WORKED REPORT
STD. 634 (REV. 2/2014)
PAY PERIOD
SEMIMONTHLY STATUS ONLY ALTERNATE WORKWEEK SCHEDULE
5. ABSENCE WITH PAY
INDUSTRIAL ILLNESS OR INJURY
6. ABSENCE WITHOUT PAY
PAY PERIOD IS
7. DATES OF ABSENCES AND EXTRA TIME WORKED
(Enter symbol and number of hours in date blocks. See reverse for legends and symbols not noted above. If the absence is for a compensable injury waiting period, add X to other symbol.)
9. CERTIFICATE BY EMPLOYEE
To the best of my knowledge and belief, the facts stated are accurate and in full compliance with legal requirements.
10. RECOMMENDATION AND SUBSTANTIATION OF SUPERVISOR
11. PERIOD ON DISABILITY COMPENSATION 12. DISABILITY COMPENSATION SUPPLEMENT 13. OFFICIAL DEPARTMENTAL ACTION
HOURS
1. MONTH YEAR
TIME BASE WWG CB/ID
First
Half
Second
Half
4/10/40
9/8/80
2. NAME (First) (Middle) (Last)
3. EMPLOYEE ID 4. POSITION NUMBER
SICK LEAVE
SELF
SICK LEAVE
FAMILY ILLNESS
(SL)
(SL)
PERSONAL
LEAVE
ANNUAL LEAVE
(PL)
(AL)
VACATION
(VA)
PLP 2012
PLP 2010
(LV)
(LP)
FURLOUGH
HOURS
BEREAVEMENT
LEAVE
(FH)
(BL)
USING OVERTIME
CREDITS (CTO)
(CT)
USING HOLIDAY
CREDITS
USING EXCESS
HOURS CREDIT
(HC)
(EX)
USING PERSONAL
HOLIDAY
PAID EDUCATIONAL
LEAVE
(PH)
(EL)
PROFESSIONAL
DEVELOPMENT DAY
(PT)
SHORT-TERM MILITARY LEAVE
(Calendar Days)
CATASTROPHIC LEAVE
DONATIONS RECEIVED AND USED
(C)
(ML)
NONINDUSTRIAL INJURY
(NDI)
TEMPORARY DISABILITY
(TD)
INDUSTRIAL DISABILITY LEAVE
(IDL)
INDUSTRIAL DISABILITY LEAVE
WITH SUPPLEMENTATION
(IDL/S)
(Attach Military Duty Orders)
OTHER
PERSONAL
LEAVE 2003
(LD)
HOLIDAY INFORMAL
TIME OFF
(HI)
PARR
(PA)
VOLUNTARY
PERSONAL LEAVE
(PV)
JURY DUTY
(JD)
ATTENDANCE FEE TO BE REMITTED
(Make copy for Accounting)
NO ATTENDANCE FEES RECEIVED
COURT CITY
WITNESS (Make copy for Accounting)
(SW)
CIVIL CASE FEES TO BE REMITTED
NO FEES RECEIVEDCRIMINAL CASE
YES NO
SUBPOENAED EXPERT
IN THE INTEREST OF/ON
BEHALF OF THE STATE:
NON QUALIFYING
QUALIFYING
INFORMAL LEAVE GRANTED
(15 Working days or less) (CSUS)
INFORMAL LEAVE GRANTED
(11 Working days or less)
FMLA
TEMPORARY LEAVE
(30 Calendar days or less)
ABSENCE WHILE SERVING
A PROBATIONARY PERIOD
ABSENCE WITHOUT LEAVE
(AWOL) (19996.2 or 19572)
To the best of my knowledge and belief, the facts stated are accurate and in full compliance with legal requirements.
1 2 3 4
TOTAL
3130292827262524232221201918171614 151312111098765
7A.
7B.
7C.
7D.
7E.
7F.
7G.
7H.
7I.
HRLY INT/PY
HRS TO BE
PAID
SICK
BEREAVEMENT
VACATION
A/L
CT, HC, EX, FM,
PH, EL, ML, JD,
DK
STRAIGHT
TIME, P, HC,
CT, EX
PREMIUM
TIME CT, P
8. REASON FOR ABSENCE OR EXTRA HOURS WORKED
@
@
SIGNATURE OF SUPERVISOR
EMPLOYEE SIGNATURE DATE
DATE
APPROVAL
NOT RECCOMENDED
APPROVAL
RECOMMENDED
FROM TO SICK LEAVE VACATION CTO HOLIDAY CREDIT
DISAPPROVED
APPROVED
REVIEWED BY
(DK)
(DK)
(DK)
CFRA
PDL
FMLA MILITARY
CAREGIVER LEAVE
(FM)
SW, MN, PL, LV, LP,
FH, PV, HI, PT, PA
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STATE OF CALIFORNIA - DEPARTMENT OF HUMAN RESOURCES
ABSENCE AND ADDITIONAL TIME WORKED REPORT
STD. 634 (REV. 2/2014)
2) subpoenaed witnesses not testifying on behalf of the State who elect
to retain the attendance fees, 3) expert witnesses not testifying on
behalf of the State, and 4) jurors who elect to retain the attendance
fees. Subpoenaed witness fees for a civil trial are governed by
Government Code (GC) Sections 68093-68097.10, fees for a criminal
trial are governed by Penal Code Section 1329-29.1, and expert fees
are governed by GC Section 68092.5. See SAM Sections 8594-94.3.
7g. Post proper symbol and number of hours for type of absence reporting.
Approved absence without pay -Approved dock
Absence without pay -AWOL
An Unapproved Absence Without Pay -- Can be any amount of time.
If the absence exceeds five (5) consecutive working days, this
constitutes an automatic resignation from State service pursuant to
Government Code 19996.2 (without fault) or an adverse action can
be taken under Government Code 19572 (with fault).
7h. Enter symbols and hours to be compensated at straight time as
indicated below:
CT - Overtime worked for CTO
P - Overtime hours worked for pay
HC -
Hours worked on a holiday
EX - Excess hours worked due to irregular work shift
7i. Enter symbols and hours to be compensated at premium time
as indicated below (Personnel Office will convert to time and
one-half (1-1/2)):
CT - Overtime worked for CTO
P - Overtime hours worked for pay
Note: Total column may be used for Items 7b through 7i.
8. Reason for Absence or Extra Hours Worked - Examples include:
Relationship information for sick leave absences (do not include a
description of illness, condition, or diagnosis) or bereavement leave.
Note: This item also can be used for reporting reasons for overtime hours
worked or for unpaid absences.
9. Employee's Responsibility and Signature - Employees have the
responsibility to give their supervisor advance notification when they
anticipate a future absence. When an unanticipated emergency causes
the absence, the employees are responsible for notifying their supervisor
as soon as possible and keeping their supervisor informed as to the
possible date of return. Employees are also responsible for promptly
reviewing and signing their absence report at the end of the pay period
and submitting to their supervisor.
10. Recommendation of Supervisor's Responsibility - Each supervisor is
responsible for seeing that employees comply with the regulations
governing absence from work. Supervisor is then responsible for promptly
reviewing and signing the employee's absence report and forwarding it to
the Personnel Office.
Before recommending approval for sick leave by an INTERMITTENT
EMPLOYEE, supervisor shall certify that the employee was scheduled to
work during the hours reported for sick leave.
Note: Methods of verification can include telephone or physician statement.
11-13. Completed by Personnel Office only.
GENERAL INFORMATION
1. All absences or additional hours worked by full-time or part-time employees should be reported on one form STD. 634 for each pay period. Report all time
worked for permanent intermittent and part-time employees.
2. Prepare the number of copies required by your department. Employees who want a copy for their own records, including supervisor's signature, may prepare
an extra copy.
INSTRUCTIONS
WWG E and SE employees must contact their personnel offices for instructions
INSTRUCTIONS FOR FILLING OUT FORM STD. 634 BY ITEM NUMBER (see reverse side)
1. Enter pay period, month, and year, and complete other boxes as required
by your department.
2-4. Complete name, employee identification (if applicable), and position number.
5. Absences With Pay - Check appropriate box, indicating type(s) of absence(s).
6. Absences Without Pay (Dock) - Complete all boxes, indicating type of
unpaid absence and if the current pay period is qualified or nonqualified.
Last box can be checked if employee is serving a probationary period to
determine if employee will complete required number of working days.
Qualifying Pay Period - Eleven (11) or more paid days in a monthly pay period.
Nonqualifying Pay Period - Less than eleven (11) paid days in a monthly pay
period.
Note: If the employee is absent without pay for more than eleven (11)
consecutive working days, which fall between two (2) consecutive otherwise
qualifying pay periods, one (1) pay period shall be disqualifying.
7. Dates of Absences and Extra Hours Worked
7a. Enter time to be paid for each day, including paid absence hours for
intermittent or part-time employees.
Note: Enter all hours to be paid in the total column.
7b. Sick and Sick Family - Provisions on the usage of sick and family sick
leave are outlined by the memorandum of understanding between
your exclusive representatives and the State of California.
Indicate sick leave hours with a symbol "SL" on date of absence.
7c. Bereavement Leave - Provisions for bereavement leave are outlined
by the memorandum of understanding between your exclusive
representative and the State of California.
7d. Vacation - may be used in less than one (1) hour increments as
outlined by the memorandum of understanding between your
exclusive representative and the State of California and is shown on
the appropriate date with the symbol "VA".
7e. Annual Leave - The "AL" symbol shall be used to indicate when
annual leave credits have been used.
7f. Post proper symbol and number of hours for type of absence being
reported.
MN - Mentoring Leave - eligible employees may receive up to
40 hours mentoring leave per calendar year once they have
used an equal amount of their leave or personal time for
this activity.
FM - Family and Medical Leave Act - under certain conditions,
entitles employees up to 12 weeks of unpaid leave per year.
Military Leave - Attach a copy of any applicable military order.
Every calendar day must be recorded, including any Saturday,
Sunday,
or holiday.
Jury Duty or Witness - An employee may be absent with pay for
time actually served to perform jury duty, for time as a subpoenaed
witness (other than a party to the suit), and for time as an expert
witness testifying on behalf of the State. It is up to the employee to
demand of the party requesting their appearance a subpoena and all
allowable attendance and travel fees. The following absences are not
compensable and the employee must charge leave or absence
without pay: 1) subpoenaed witnesses who are a party to the suit,