Time Clock Adjustment Form
|Name |Employee ID # |Week of |
|Check all Boxes that Apply |
| Clock In/Out (fill out calendar below) Explanation: | Lunch Adjustment (fill out calendar below) | Project # Correction (fill out calendar below) |
| |Explanation: |Explanation: |
| Billable Overtime (fill out calendar below) | Comp Time Earned in Lieu of Overtime Pay (fill out calendar below) |
|Note – Total overtime worked in a day must be taken as either overtime pay or compensatory time earned. Daily overtime cannot be split between the two. |
| Family and Medical Leave Work-Related Injury or Illness Neither |
| Leave Request/Adjustment (again, check all boxes that apply) |
|Paid Leave |
|Dates |
|# Hours |
| |
|Unpaid Leave |
| |
|Compensatory Time |
| |
| |
| |
|Medical* Personal* |
| |
|Jury Duty or Court Appearance* |
| |
| |
| |
| |
| |
|Military Leave* |
| |
| |
| |
| |
| |
|Organ Donation Leave |
| |
| |
| |
| |
| |
|Parental Leave |
| |
| |
| |
| |
|Dates |
|# Hours |
| |
|Sick Leave* |
| |
| |
| |
|Unpaid Time Off (10 or fewer consecutive working days) |
| |
| |
| |
|University Business |
| |
| |
| |
| |
| |
| |
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|Vacation |
| |
| |
| |
|Unpaid Leave of Absence (more than 10 consecutive working days) |
| |
| |
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|Vacation in place of sick leave |
| |
| |
| |
| |
| |
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| |
|Additional Information (reason for absence, etc.) |
| |
| |
| |
|Above leave is a change to a previously entered and approved leave request. yes no |
|Leave request was entered manually to the timesheet by the manager. yes no |
|Calendar |
|Sunday |Monday |Tuesday |Wednesday |Thursday |Friday |Saturday |
|In |In |In |In |In |In |In |
|Out |Out |Out |Out |Out |Out |Out |
| | | | | | | |
|Hrs |Hrs |Hrs |Hrs |Hrs |Hrs |Hrs |
| | | | | | | |
|Proj # |Proj # |Proj # |Proj # |Proj # |Proj # |Proj # |
| | | | | | | |
|From |From |From |From |From |From |From |
|To |To |To |To |To |To |To |
|Employee Certification - I understand that approval of this request is contingent upon the availability of adequate leave balances. Falsification of this |
|Application for Leave or of the supporting documentation is grounds for disciplinary action, up to and including dismissal. |
|Employee Signature | Acknowledge OSU Leave Policy |Date |
| | | |
|Amended by Date |Approved by Date |WorkForce Updated by Date |
|• All updates must be approved by manager. |
|• Submit a copy to A&P Human Resources at the end of the pay week. |
|* Requires appropriate documentation. Documentation attached. |
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