ࡱ> ?D>o kbjbj ?*zfzfk$L     []]]]]]$L     [[ C8hG0N`U~X N: FONTANA UNIFIED SCHOOL DISTRICT NOTIFICATION OF TEMPORARY CHANGE OF STATUS INSTRUCTIONS: This form is to be used in reporting actual time worked in a classification for which you should receive additional remuneration. Please submit this report with your Classified Employee Service Report. Payment will be processed monthly and the payment for services rendered should be received with your paycheck at the end of each month. It is imperative that this form be filled out in its entirety. NAME OF EMPLOYEE WORKING IN TEMORARY STATUS: EMPLOYEES REGULAR LOCATION: SERVICE PERIOD ENDING: SUBSTITUTED FOR: (Name of Absentee)LocationDateHours Accounting Use I certify the above dates and hours shown are correct and accurate. _______________________________________ Employee Signature Approval and Verification by Supervisor: _______________________________________ Social Security No.: Last 4 digits only _______________________________________ Department Head/Supervisor Signature ---------------------------------------------------------------------------------------------------------------------------- BUSINESS DEPARTMENT USE ONLY Range _____ @ _____ + Increase Range _____ @ _____= Regular Hours _____ @ ___________ (Differential) Range _____ @ _____ + Increase Range _____ @ _____= Regular Hours _____ @ ___________ (Differential) ACCOUNT NUMBER _________________________________________________________________ Revised 11/18/11  KLYZ w x ~  ! " # > ? H I J _ ` j k l ʺvvvfh= hb9CJOJQJaJ"h= hb9>*CJOJQJaJ"h= hT9>*CJOJQJaJh= hSBw9CJOJQJaJh= hT9CJOJQJaJh= hb9CJOJQJaJ"h= hb59CJOJQJaJ"h= h`59CJOJQJaJ"h= hb59CJOJQJaJ! KL " # I J k l $$Ifa$gdbgdb$a$gdT$ ^`a$gdT$a$gdbl > ? @ f o p w ͽh= h+9CJOJQJaJh= hb9CJOJQJaJh= hT9CJOJQJaJh= hb9CJOJQJaJh= hb9CJOJQJaJ#h= hb9CJOJQJ^JaJh= hb9CJOJQJaJ7 4+++ $Ifgdbkd$$IfTlIr q#( '''t' 2#644 la]p2T Lkd;$$IfTlr q#'( '''t'#644 la]p2T $Ifgdb ULLLLL $Ifgdbkd4$$IfTlr q#'( '''t'#644 la]p2T ULLLLL $Ifgdbkd-$$IfTlr q#'( '''t'#644 la]p2T ULLLLL $Ifgdbkd&$$IfTlr q#'( '''t'#644 la]p2T ULLLLL $Ifgdbkd$$IfTlr q#'( '''t'#644 la]p2T > ? @ p UPPPPPPPPgdbkd$$IfTlr q#'( '''t'#644 la]p2T  4 < = D i j   T Z [ v Ͽϝ{{{k[Kkh= h+9CJ OJQJaJh= h+9CJOJQJaJh= h= 9CJOJQJaJ"h= h+59CJOJQJaJh= h+9CJOJQJaJh= h+9CJOJQJaJ"h= hT59CJOJQJaJh= hT9CJOJQJaJh= hb9CJOJQJaJh= hb9CJOJQJaJh= hT9CJOJQJaJ  = i j   [ YZk$a$gdwgd+gd= $a$gd+gdb XYZjkͽh= h= 9CJOJQJaJh= hb9CJOJQJaJh= h+9CJOJQJaJh= h= 9CJ OJQJaJ"h= h+69CJOJQJaJh= h+9CJ OJQJaJh= h+9CJOJQJaJ = 0PP1:p+/ =!"#@$@% 9$$If]!vh#v( #v#v#vt#v:V lI 2#6,5( 555t59/  /  / / a]p2T$$If]!vh#v( #v#v#vt#v:V l#6,5( 555t59/ / / /  a]p2T$$If]!vh#v( #v#v#vt#v:V l#6,5( 555t59/ / / /  a]p2T$$If]!vh#v( #v#v#vt#v:V l#6,5( 555t59/ / / /  a]p2T$$If]!vh#v( #v#v#vt#v:V l#6,5( 555t59/ / / /  a]p2T$$If]!vh#v( #v#v#vt#v:V l#6,5( 555t59/ / / /  a]p2T$$If]!vh#v( #v#v#vt#v:V l#6,5( 555t59/ / / /  a]p2Ty2 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@666666_HmH nH sH tH H`H Normal9CJ ^J_HaJ mH sH tH DA D Default Paragraph FontRi@R  Table Normal4 l4a (k (No List l$l o68Envelope Address!@ &+D/^@ CJOJQJaJJ%J fEnvelope ReturnCJOJQJaJPK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭Vj\{cp/IDg6wZ0s=Dĵw %;r,qlEآyDQ"Q,=c8B,!gxMD&铁M./SAe^QשF½|SˌDإbj|E7C<bʼNpr8fnߧFrI.{1fVԅ$21(t}kJV1/ ÚQL×07#]fVIhcMZ6/Hߏ bW`Gv Ts'BCt!LQ#JxݴyJ] C:= ċ(tRQ;^e1/-/A_Y)^6(p[_&N}njzb\->;nVb*.7p]M|MMM# ud9c47=iV7̪~㦓ødfÕ 5j z'^9J{rJЃ3Ax| FU9…i3Q/B)LʾRPx)04N O'> agYeHj*kblC=hPW!alfpX OAXl:XVZbr Zy4Sw3?WӊhPxzSq]y k *l k  k 8@0(  B S  ?m|m3YZ66wx!>H_j@@fopp 4<DDjjTZ[[hjmYZ66wx!>H_j@@fopp 4<DDjjTZ[[Xjm)pno68VfSBwVax= |J|rfT`lCwb^7+km@k@UnknownG.[x Times New Roman5Symbol3. .[x ArialE. Century GothicC.,*{$ Calibri Light7.*{$ CalibriA$BCambria Math"hKZygKZyg{Fv v !@24hh3HX ?`2!xxx<:X FONTANA UNIFIED SCHOOL DISTRICTPayrollDavid G. Alcala Oh+'0   @ L X dpx FONTANA UNIFIED SCHOOL DISTRICTPayroll Normal.dotmDavid G. Alcala2Microsoft Office Word@@4@kh@khv ՜.+,D՜.+,P  hp  fusd h  FONTANA UNIFIED SCHOOL DISTRICT Title40x _dlc_DocId_dlc_DocIdItemGuid_dlc_DocIdUrlMTRQYKQWRUNQ-14-581(7e1da97b-37f8-4a37-a9fc-77ccb33ecc5a`https://portal.fusd.net/_layouts/DocIdRedir.aspx?ID=MTRQYKQWRUNQ-14-581, MTRQYKQWRUNQ-14-581  !"#$%&'()*+,-/012345789:;<=@ABCFYHIJKLMNOPQRSTUVWXZ[\]^_Root Entry FC8hE@Data 1TableWordDocument?*SummaryInformation(.DocumentSummaryInformation86MsoDataStore C8hC8hJ1N0EGZTQ==2C8hC8hItem  PropertiesO2BA53UGUSNNVBA==2 C8hC8hItem  G#Properties @WAQVFGGGFONEEAQ==2C8hC8hItem PropertiesSOMIUETHKNY==2C8hC8hItem #eProperties=ACompObjCr  !"$%&'()*+,-./0123456789:;<>?DocumentLibraryFormDocumentLibraryFormDocumentLibraryForm This value indicates the number of saves or revisions. The application is responsible for updating this value after each revision. metaAttributes"/> Document ID GeneratorSynchronous100011000Microsoft.Office.DocumentManagement, Version=14.0.0.0, Culture=neutral, PublicKeyToken=71e9bce111e9429cMicrosoft.Office.DocumentManagement.Internal.DocIdHandlerDocument ID GeneratorSynchronous100021001Microsoft.Office.DocumentManagement, Version=14.0.0.0, Culture=neutral, PublicKeyToken=71e9bce111e9429cMicrosoft.Office.DocumentManagement.Internal.DocIdHandlerDocument ID GeneratorSynchronous100041002Microsoft.Office.DocumentManagement, Version=14.0.0.0, Culture=neutral, PublicKeyToken=71e9bce111e9429cMicrosoft.Office.DocumentManagement.Internal.DocIdHandlerDocument ID GeneratorSynchronous100061003Microsoft.Office.DocumentManagement, Version=14.0.0.0, Culture=neutral, PublicKeyToken=71e9bce111e9429cMicrosoft.Office.DocumentManagement.Internal.DocIdHandler   F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q