ENUMCLAW SCHOOL DISTRICT #216
SPECIAL PAY REQUEST
Activities / Event Coverage
Special pay requests will be paid each month. All hours may be turned in on one form. Forms must be submitted to Payroll
by 4 pm on the second Friday of each month for payment that month.
Employee Name
__
Signature
Type or Print
Certified/ Classified (Please Circle)
Location_________________________________________
Use additional sheets if necessary.
Date
Make a copy for your files.
Activities/ Athletic Event Supervision (4 hours Maximum)
Certified Staff @ $16.50 per hour
Classified Staff @ per diem or time and half
MM/DD/YY
Event
Location
# of Hours
Budget Number
Supervisor Signature
MM/DD/YY
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Location
# of Hours
Budget Number
Supervisor Signature
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Location
# of Hours
Budget Number
Supervisor Signature
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Location
# of Hours
Budget Number
Supervisor Signature
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Location
# of Hours
Budget Number
Supervisor Signature
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Location
# of Hours
Budget Number
Supervisor Signature
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Location
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Budget Number
Supervisor Signature
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Location
# of Hours
Budget Number
Supervisor Signature
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Location
# of Hours
Budget Number
Supervisor Signature
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Location
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Budget Number
Supervisor Signature
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Location
# of Hours
Budget Number
Supervisor Signature
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Location
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Budget Number
Supervisor Signature
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Location
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Supervisor Signature
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Supervisor Signature
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Supervisor Signature
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Location
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Budget Number
Supervisor Signature
PR8
Rev 4/09
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