Name:      
Employee #-	     
Department /Subject:	     
Temporary Duty Dates:	     
     
Location:	     
 
     
     
This is my	     
     
Substitute Funding Source:	     
Date:	     
Date:	     
Date:	     
     
Substitute Locator:	     
     
Payroll Secretary:	     
     

John A. Ferguson Senior High School

Request for Temporary Duty

If temporary leave begins in one payroll period and ends in another payroll period, two
request forms should be completed. List the dates of leave during one payroll period on
one form and the dates of leave during the next payroll period on the other form.

1 .

Activity or Event (please provide documentation):

2.

3.

Hours (please check one):

AM

PM

All Day

Request for Temporary Duty this school year.

Number of days previously taken for Temporary Duty during this school year:-

Employee's Signature:

Department Chair:

Assistant Principal:

Principal:

Date:

Completed and approved forms are to be returned to Mrs. Julie Andion.

For Office Use Only:

Date

Date