This form is used to report all absences and additional time worked (with the exception of premium paid overtime) and to substantiate entries on the Attendance Report (672).

• The original Absence and Additional Time Worked Report (634) must be submitted to Payroll Services along with the Attendance Report (672). If the absence is for Jury Duty, an original Jury Duty confirmation form, plus one copy, must be submitted.
• For multiple position with different supervisors, submit one report for each supervisor
• If an absence runs into two different pay periods, a separate Absence and Additional Time Worked Report must be submitted for each pay period.

GENERAL INFORMATION

1. All absences or additional hours worked by full-time or part-time employees should be reported on one form (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 FOR FILLING OUT THE ABSENCE AND ADDITONAL TIME WORKED BY ITEM NUMBER

1. Enter pay period, month, and year and complete other boxes as required by your department.

2-4. Complete name, social security number, 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 absence and if the current pay period is qualified or non-qualified. 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
Non-qualifying 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 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 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 leave are outlined by the memorandum of understanding between your exclusive representatives and the State of California.

Indicate sick leave hours with a symbol of "S" or "SF" on date of absence. If more than two (2) hours are needed for a doctor's appointment, the reason should be stated in Item 8. Enter the symbol and the number of hours under the number(s) corresponding to the duties be reported.

7c. Bereavement Leave- Provisions for bereavement leave are outlined by the memorandum of understanding between your exclusive representative and the State of California.

Sick Death - Employee in bargaining unites which did not negotiate bereavement leave provisions may use up to five (5) days of their sick leave balance for each family member.

7d. Vacation - may be used in 30 minute or one (1) hour increments as outlined in the memorandum of understanding between your exclusive representative and the State of California and is shown on the appropriate date with the symbol "V".

An absence can be charged against vacation credits only approved by the appointing power. The time at which vacation shall be taken my be specified to suit the convenience of the department.