Home InstructionBiweekly Time Sheet

SCHOOL NAME: Glencoe District High School DATE: 2016 April 08

Pupils Name Emily Burdick

Teacher’s Name Ebony Pasquarelli Employee ID No. 52474

TWO WEEK PERIOD OF INSTRUCTIONFrom 2016 03 28 To 2016 04 10

YYYY MM DD YYYY MM DD

Ebony PasquarelliTeacher’s Signature Principal’s Signature

Please PRINT Principal name:

Individual Dates(eg. 2013 October 5) Subject Total Hours

(each day)2016 March 31 Science 22016 April 07 Science 2

TOTAL 4

The rate of pay for Home Instruction is $26.00 per hour, including vacation pay.Principal is to confirm hours and calculations prior to signing the form.

DO NOT SEND DUPLICATE TIME SHEETS - IF NECESSARY, CALL TO CONFIRM

TO ENSURE TIMELY PAYMENT OF WAGES AND RELATED REPORTING, THIS TIMESHEET IS TO BESUBMITTED ON A BIWEEKLY BASIS TO THE SUPERINTENDENT OF EDUCATION – HOME INSTRUCTION

AT CEC CENTRAL BY FAX 519-452-2485, OR BOARD COURIER.DO NOT SEND TIMESHEETS VIA EMAIL AND DO NOT ACCUMULATE TIMESHEETS.

FOR USE BY SUPERINTENDENT OF STUDENT ACHIEVEMENT – HOME INSTRUCTION1. Review for accuracy and completeness2. Payments are to be charged to: Elementary 10 173 0001 000

Secondary 10 173 0004 0003. Approve and forward to Payroll Services for payment.

Approved by: Date:Superintendent of Student Achievement – Home Instruction

RETENTION: Responsibility of Payroll Department (C + 6). Notice of Collection: The personal information provided on this form and any other correspondence relating to involvement in Board programs is collected by the Thames Valley District School Board under the authority of the Education Act and Regulations (R.S.O. 1990 c.E.2) as amended. The information will be used to register the student in a school, for the collection of applicable student/activity fees, as well as for any consistent purpose. Information is shared with employees such that they may carry out their job duties. In addition the information may be used or disclosed to comply with legislation, for compelling circumstances affecting health and safety or discipline, as required in circumstances related to law enforcement matters, or in accordance with any other Act. For questions about this collection, contact the Board’s Freedom of Information Co-ordinator, Thames Valley District School Board, 1250 Dundas Street, London, Ontario, N6A 5L1, Telephone 519-452-2000 ext. 20218. (Revised April 2013)

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