ZJAQ-Substitute Compensation
Request Form
Is substitute a current employee at the school?
*
Yes
No
Substitute Information
Name
*
First Name
Last Name
E-mail Address
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Instances
Please choose Hourly or Daily
*
Please Select
Hourly
Daily
Date Substituted
*
/
Month
/
Day
Year
Date
Number of Hours
*
include decimals for partial hours
Rate/Additional Rate per Hour
*
Number of Days
*
include decimals for partial hours
Date 1
*
-
Month
-
Day
Year
Date
Date 2
*
-
Month
-
Day
Year
Date
Date 3
*
-
Month
-
Day
Year
Date
Date 4
*
-
Month
-
Day
Year
Date
Date 5
*
-
Month
-
Day
Year
Date
Rate per Day
*
Compensation
$
For class/employee
*
Would you like to add another instance?
*
Yes
No
Please choose Hourly or Daily
*
Please Select
Hourly
Daily
Date Substituted
*
/
Month
/
Day
Year
Date
Number of Hours
*
include decimals for partial hours
Rate/Additional Rate per Hour
*
Number of Days
*
Date 1
*
-
Month
-
Day
Year
Date
Date 2
*
-
Month
-
Day
Year
Date
Date 3
*
-
Month
-
Day
Year
Date
Date 4
*
-
Month
-
Day
Year
Date
Date 5
*
-
Month
-
Day
Year
Date
Rate per Day
*
Compensation
$
For class/employee
*
Would you like to add another instance?
*
Yes
No
Please choose Hourly or Daily
*
Please Select
Hourly
Daily
Date Substituted
*
/
Month
/
Day
Year
Date
Number of Hours
*
include decimals for partial hours
Rate/Additional Rate per Hour
*
Number of Days
*
include decimals for partial hours
Date 1
*
-
Month
-
Day
Year
Date
Date 2
*
-
Month
-
Day
Year
Date
Date 3
*
-
Month
-
Day
Year
Date
Date 4
*
-
Month
-
Day
Year
Date
Date 5
*
-
Month
-
Day
Year
Date
Rate per Day
*
Compensation
$
For class/employee
*
Total Compensation
$
Submitted by
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Supervisor Signature
*
Today's Date
*
/
Month
/
Day
Year
Date
Submit
Should be Empty: