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Page 1: **PLEASE PRINT Employee Name ( Last Name, First Name MI

ATTENDANCE & LEAVE REPORT( CHARGED PAY )

**User ID

**PLEASE PRINT Employee Name ( Last Name, First Name MI )

**Employee Signature **Date

Approver Email

I hereby certify that I have reviewed this recordand that it represents a true and correct recordof hours worked, authorized overtime andauthorized leave. Intentional falsification of thisreport shall be cause for dismissal in accordancewith the Florida Administrative Code.

FAX TO 800-272-2830

**PLEASE PRINT Approver Name ( Last Name, First Name MI )

**Date**Approver Signature

**Approver User ID

**Pay Period From ( MM / DD / YY )

**Pay Period To ( MM / DD / YY )

CHARGE OBJECT ACTIVITY SUB ACT

HRS TYPE

HOURS(HRS | MIN)

HRS TYPE

HOURS(HRS | MIN)

HRS TYPE

HOURS(HRS | MIN)

HRS TYPE

HOURS(HRS | MIN)

HRS TYPE

HOURS(HRS | MIN)

HRS TYPE

HOURS(HRS | MIN)

HRS TYPE

HOURS(HRS | MIN)

ONLY ORIGINAL FORMS ON LEGALSIZED PAPER WILL BE PROCESSED

TOTALHRS DAILY

Approver Tel #

**Position Code**Agency

Page Of

RF

I

SUN

SAT

MON

TUE

WED

THU

TOTAL HOURSWEEK

TOTAL HOURSLEAVE

TOTAL HOURSWORKED

FMLA FMLA FMLA FMLA FMLA FMLA FMLA

STATE OF FLORIDA

OT Code OT Hours

OT Code OT Hours

OT Code OT Hours

OT Code OT Hours

OT Code OT Hours

OT Code OT Hours

OT Code OT Hours

OT Code OT Hours

OT Code OT Hours

OT Code OT Hours

OT Code OT Hours

OT Code OT Hours

OPS

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Page 2: **PLEASE PRINT Employee Name ( Last Name, First Name MI

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