Graduate/Teaching Assistant Attendance Form

Office of Human Resources and Payroll
dlooney@brockport.edu

1Employee Details and Certification > 2Supervisor Certification
Submit this form to the Payroll Office no later than the fifth (5th) day of the month following the reporting month.
Attendance Record for Month of
Attendance Record for Year of
Name - GA/TA Employee Name - GA/TA Employee First Last
Email - GA/TA Employee
Name - GA/TA Supervisor Name - GA/TA Supervisor First Last
Email - GA/TA Supervisor
Indicate if

Indicate if No chargeable absence Charge absence(s)
ABSENCE REPORT - SICK Leave
- ● 5 days available for use in Spring semester ONLY after completing Fall semester obligation.
- ● Days earned in Spring do not carry to the next Fall semester.
- ● List date(s) and 1/4-day increments of time absent. For example:
  .25 day - MM/DD/YYYY
  1 day - MM/DD/YYYY
Personal Illness - List date(s) and time(s)
Leave for Illness or Death in Immediate Family - List date(s) and time(s)
EMPLOYEE CERTIFICATION OF ATTENDANCE FORM
GA/TA: Select the button to indicate your agreement with the statement.

GA/TA: Select the button to indicate your agreement with the statement. I hereby certify that I was present and performed my work obligations as required throughout the month, except for those absences noted above.
GA/TA: Type your name as your signature into the box below.

I understand this is a legal representation of my signature.
Date signed Date signed / MM / DD YYYY
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Graduate/Teaching Assistant Attendance Form

Submit this form to the Payroll Office no later than the fifth (5th) day of the month following the reporting month.

ABSENCE REPORT - SICK Leave

EMPLOYEE CERTIFICATION OF ATTENDANCE FORM

SUPERVISOR NEXT STEP: