PAYROLL/PERSONNEL REPORTING FORM

NAME
CS N#
BANNER ID
DEPARTMENT	AIS BUDGET PURPOSE
A.	HOURS WITHOUT PAY	Date(s)
Employee is on:	Medical Leave	Non-Medical Leave
B.	COMPENSATORY TIME (MUST BE APPROVED IN ADVANCE)
Date(s)
OVERTIME HOURS WORKED

X 1.5 =	Total
Less Compensating Overtime Used
Total TO BE ENTERED IN PEALEAV
*Compensatory time must be used within 60 days of earning it or it will be zeroed out*
C.	OVERTIME TO BE PAID (MUST BE APPROVED IN ADVANCE)
Date(s)
OVERTIME HOURS WORKED (TOTAL TO BE PAID)	*Enter actual overtime hours worked over, do not multiply by 1.5*
D.	LEAVE OF ABSENCE	Reason for Leave
(This may include Worker’s Comp, Disability, FMLA, Medical, Personal or Military Leaves)
Date Leave Begins:	Date Leave Ends:
Last Day Worked:	Last Day Paid:
Sick Leave Hours TO BE PAID	Vacation Hours TO BE PAID
Unpaid Leave (EMPLOYEE REMAINS OFF PAYROLL UNTIL DEPT. NOTIFICATION)
Date:
Return from Unpaid Leave
Date:
Date
Department Representative
Date
Fiscal Officer/Designated Representative
Date
Vice Chancellor or Functional Area Director (Required for Overtime Only)
Date
Human Resources Representative

09/12

PAYROLL/PERSONNEL REPORTING FORM

lscrogg

2012-09-04

Joyree Chura

SIUE