Employment Services Work First Time Sheet
Total Page：16
File Type：pdf, Size：1020Kb
EMPLOYMENT SERVICES WORK FIRST MONTHLY TIME SHEET Due By The 5 th work day of the Following Month
Name / SS#: ______Employment Worker / DIST #: ______August 2014
SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY ACTIVITY 1 2
ACTIVITY 3 4 5 6 7 8 9
ACTIVITY 10 11 12 13 14 15 16
EMPLOYER NAME 17 18 19 20 21 22 23
LENGTH OF LUNCH 24 25 26 27 28 29 30 BREAK
ARE YOU PAID FOR 31 LUNCH BREAK?
Component or Employer Signature: ______SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY ACTIVITY 1 2
ACTIVITY 3 4 5 6 7 8 9
ACTIVITY 10 11 12 13 14 15 16
EMPLOYER NAME 17 18 19 20 21 22 23
LENGTH OF LUNCH 24 25 26 27 28 29 30 BREAK
ARE YOU PAID FOR 31 LUNCH BREAK?
Component or Employer Signature: ______
Customer Signature: ______Telephone Number: ______
August 2014
(11/08) SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY ACTIVITY 1 2
ACTIVITY 3 4 5 6 7 8 9
ACTIVITY 10 11 12 13 14 15 16
EMPLOYER NAME 17 18 19 20 21 22 23
LENGTH OF LUNCH 24 25 26 27 28 29 30 BREAK
ARE YOU PAID FOR 31 LUNCH BREAK?
Component or Employer Signature: ______SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY ACTIVITY 1 2
ACTIVITY 3 4 5 6 7 8 9
ACTIVITY 10 11 12 13 14 15 16
EMPLOYER NAME 17 18 19 20 21 22 23
LENGTH OF LUNCH 24 25 26 27 28 29 30 BREAK
ARE YOU PAID FOR 31 LUNCH BREAK?
Component or Employer Signature: ______
Customer Signature: ______Telephone Number: ______
(11/08)