Benefit Time Record (revised) "*" indicates required fields Benefit time record for full-time exempt staffYour name* Your email (if you would like a copy) Month of BTR*JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberYear of BTR*202420252026For the month listed, I worked full days on all of the weekdays during the month.*This means that, except for weekends, there was no time off during the month for any reason (e.g., PTO, holiday, bereavement, jury duty, paid parental leave, paid urgent leave, volunteering, College-declared emergency, unemployed days, etc.). Yes No For the month listed, I was off work on a weekday for the following:* Paid time off Holiday Bereavement Jury duty Paid parental leave Paid urgent leave Volunteer time College-declared emergency Days before my first day or after my last day Academic year employee scheduled off for part of the year PTOIf you would like more information on the paid time off, please see the Employee Handbook.PTO 1* MM slash DD slash YYYY Amount* 2 hours 4 hours 6 hours 8 hours (all day) Do you need to add a second entry for PTO?* Yes No PTO 2* MM slash DD slash YYYY Amount* 2 hours 4 hours 6 hours 8 hours (all day) Do you need to add a third entry for PTO?* Yes No PTO 3* MM slash DD slash YYYY Amount* 2 hours 4 hours 6 hours 8 hours (all day) Do you need to add a fourth entry for PTO?* Yes No PTO 4* MM slash DD slash YYYY Amount* 2 hours 4 hours 6 hours 8 hours (all day) Do you need to add a fifth entry for PTO?* Yes No PTO 5* MM slash DD slash YYYY Amount* 2 hours 4 hours 6 hours 8 hours (all day) Do you need to add a sixth entry for PTO?* Yes No PTO 6* MM slash DD slash YYYY Amount* 2 hours 4 hours 6 hours 8 hours (all day) Do you need to add a seventh entry for PTO?* Yes No PTO 7* MM slash DD slash YYYY Amount* 2 hours 4 hours 6 hours 8 hours (all day) Do you need to add an eighth entry for PTO?* Yes No PTO 8* MM slash DD slash YYYY Amount* 2 hours 4 hours 6 hours 8 hours (all day) Do you need to add a ninth entry for PTO?* Yes No PTO 9* MM slash DD slash YYYY Amount* 2 hours 4 hours 6 hours 8 hours (all day) Do you need to add a tenth entry for PTO?* Yes No PTO 10* MM slash DD slash YYYY Amount* 2 hours 4 hours 6 hours 8 hours (all day) Do you need to add another entry for PTO?* Yes No Please enter the additional days and times you used PTO.* HolidayIf you would like more information on holiday time, please see the Employee Handbook.Holiday 1* MM slash DD slash YYYY Amount* 2 hours 4 hours 6 hours 8 hours (all day) Do you need a second entry for holiday time?* Yes No Holiday 2* MM slash DD slash YYYY Amount* 2 hours 4 hours 6 hours 8 hours (all day) Do you need a third entry for holiday time?* Yes No Holiday 3* MM slash DD slash YYYY Amount* 2 hours 4 hours 6 hours 8 hours (all day) Do you need a fourth entry for holiday time?* Yes No Holiday 4* MM slash DD slash YYYY Amount* 2 hours 4 hours 6 hours 8 hours (all day) Do you need another entry for holiday time?* Yes No Please enter the additional days and times you used holiday time.* BereavementWe are sorry for your loss. If you would like more information on bereavement time, please see the Employee Handbook.Bereavement 1* MM slash DD slash YYYY Amount* 2 hours 4 hours 6 hours 8 hours (all day) Do you need a second entry for bereavement time?* Yes No Bereavement 2* MM slash DD slash YYYY Amount* 2 hours 4 hours 6 hours 8 hours (all day) Do you need a third entry for bereavement time?* Yes No Bereavement 3* MM slash DD slash YYYY Amount* 2 hours 4 hours 6 hours 8 hours (all day) Do you need another entry for bereavement time?* Yes No Please enter the additional days and times you used bereavement time.* Obituary*Please upload the obituary of your family member.Accepted file types: pdf, Max. file size: 50 MB.Jury DutyIf you would like more information on time for jury duty, please see the Employee Handbook.Jury Duty 1* MM slash DD slash YYYY Amount* 2 hours 4 hours 6 hours 8 hours (all day) Do you need a second entry for jury duty?* Yes No Jury Duty 2* MM slash DD slash YYYY Amount* 2 hours 4 hours 6 hours 8 hours (all day) Do you need a third entry for jury duty?* Yes No Jury Duty 3* MM slash DD slash YYYY Amount* 2 hours 4 hours 6 hours 8 hours (all day) Do you need a fourth entry for jury duty?* Yes No Jury Duty 4* MM slash DD slash YYYY Amount* 2 hours 4 hours 6 hours 8 hours (all day) Do you need a fifth entry for jury duty?* Yes No Jury Duty 5* MM slash DD slash YYYY Amount* 2 hours 4 hours 6 hours 8 hours (all day) Do you need another entry for jury duty?* Yes No Please enter the additional days and times for jury duty.* Jury duty documentation*Please upload your jury duty summons.Accepted file types: pdf, Max. file size: 50 MB.Paid parental leaveIf you would like more information on paid parental leave, please see the Employee Handbook.Parental leave 1* MM slash DD slash YYYY Amount* 2 hours 4 hours 6 hours 8 hours (all day) Do you need a second entry for paid parental leave?* Yes No Parental leave 2* MM slash DD slash YYYY Amount* 2 hours 4 hours 6 hours 8 hours (all day) Do you need a third entry for paid parental leave?* Yes No Parental leave 3* MM slash DD slash YYYY Amount* 2 hours 4 hours 6 hours 8 hours (all day) Do you need another entry for paid parental leave?* Yes No Please enter the additional days and times for paid parental leave.* Paid urgent leaveIf you would like more information on paid urgent leave, please see the Employee HandbookUrgent leave 1* MM slash DD slash YYYY Amount* 2 hours 4 hours 6 hours 8 hours (all day) Do you need a second entry for paid urgent leave?* Yes No Urgent leave 2* MM slash DD slash YYYY Amount* 2 hours 4 hours 6 hours 8 hours (all day) Do you need a third entry for paid urgent leave?* Yes No Urgent leave 3* MM slash DD slash YYYY Amount* 2 hours 4 hours 6 hours 8 hours (all day) Do you need another entry for paid urgent leave?* Yes No Please enter the additional days and times for paid urgent leave.* Volunteer timeIf you would like more information on volunteer time, please see the Employee HandbookVolunteer time* MM slash DD slash YYYY Amount* 2 hours 4 hours 6 hours 8 hours (all day) Volunteer time documentation*Please upload your volunteer time approval form.Accepted file types: pdf, Max. file size: 50 MB.College-declared emergencyIf you would like more information, please see the Weather-Related and Emergency Class Cancellation Policy or Campus Closing Policy on the PantherNet.College emergency 1* MM slash DD slash YYYY Amount* 2 hours 4 hours 6 hours 8 hours (all day) Do you need a second entry for a College emergency?* Yes No College emergency 2* MM slash DD slash YYYY Amount* 2 hours 4 hours 6 hours 8 hours (all day) Do you need a third entry for a College emergency?* Yes No College emergency 3* MM slash DD slash YYYY Amount* 2 hours 4 hours 6 hours 8 hours (all day) Do you need another entry for a College emergency?* Yes No Please enter the additional days and times for College-declared emergencies.* Days before my first day or after my last dayDuring the month indicated, did you have your first or last day of employment? first day last day My first day of employment was* MM slash DD slash YYYY My last day of employment was* MM slash DD slash YYYY Academic year employeePlease enter the days off this month due to being an academic year employee.* HiddenSubmit Your Benefit Time RecordSupervisor name Supervisor email* Additional information - optional Certification* By checking this box, I certify that this BTR is accurate and correctly represents the days I worked for the College. I understand and agree that checking this box is the same as signing this form.
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