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