San Jose/Evergreen Community College District PR-2

ACADEMIC CLAIM

ADJUNCT OR OVERLOAD WAGES

Employee Number Pay Period Ending19 / Pay Period Ending / 20 / 18
Position I.D.
Name / Assignment

last name first name (ex: Coordinator, Counselor, Substitute for J. Smith, Board Grading, etc.)

Monthly Overload: / This claim must be submitted on or before the 11th day of each month for payment on the last working day of the month.
Adjunct Faculty: / This claim must be submitted on or before the last working day of each month for payment on or about the 10th day of the following month
Print with black or blue ink only. / Please copy for your records.
Dates
WEEK 1
/ Sun / Mon / Tue / Wed / Thurs / Fri /

Sat

/

TOTAL HOURS

Time In /

WEEK 1

Time Out
Time In
Time Out

TOTAL HOURS

Dates
WEEK 2 / Sun / Mon / Tue / Wed / Thurs / Fri /

Sat

/

TOTAL HOURS

Time In
Time Out
Time In
Time Out

TOTAL HOURS

Dates
WEEK 3 / Sun / Mon / Tue / Wed / Thurs / Fri /

Sat

/

TOTAL HOURS

Time In /

WEEK 3

Time Out
Time In
Time Out

TOTAL HOURS

Dates
WEEK 4 /

Sun

/ Mon / Tue / Wed / Thurs / Fri /

Sat

/

TOTAL HOURS

Time In /

WEEK 4

Time Out
Time In
Time Out

TOTAL HOURS

Dates
WEEK 5 /

Sun

/ Mon / Tue / Wed / Thurs / Fri /

Sat

/

TOTAL HOURS

Time In /

WEEK 5

Time Out
Time In
Time Out

TOTAL HOURS

Total Lecture / DLY Fact / x / days / = / Load / x / $ / = / $
Total Lab / DLY Fact / x / days / = / Load / x / $ / = / $
Total Non-Instructional / Total Hours / x / $ / 79.87 / = / $

The above claim is a legal charge against the funds of the District and is in accordance with theI hereby certify that the above claim is true and correct and that no part thereof has been paid.

rules and regulations of the San Jose/Evergreen Community College District Governing Board.

Budget Number / Signed
Claimant
Rev. 05/08 / Approved
Supervisor or Dean