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the municipal secretary desktop reference manual - Southwestern ...

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Employee:<br />

Department:<br />

RECORD OF EMPLOYEE’S DAYS OFF FOR THE YEAR<br />

Available Sick Days (+)<br />

Sick Days Used (-)<br />

Sick Days Earned in current yr.(+)<br />

Previously Accumulated sick days (+)<br />

Sick Days Purchased during current yr.(+)<br />

Year end balance<br />

Available Vacation Days<br />

Vacation Days Used<br />

Year end balance<br />

Available Personal Days<br />

Personal Days Used<br />

Year end balance<br />

Notes:<br />

Please sign and date to verify that your records agree with <strong>the</strong> above information. This<br />

form must be returned to your department head no later than<br />

. If <strong>the</strong>re are<br />

any discrepancies, please make your notes on <strong>the</strong> right side of <strong>the</strong> page.<br />

Employee’s Signature<br />

Date<br />

X-15<br />

Revised July 2003

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