Employee Time Sheet printable pdf download

Employee Time Sheet

Check One:

Cash Card

Mail

Pickup

Deposit

Facility Name:___________________________________________________

Employee Name:________________________________________________

Classification:

LPN

CNA

Other:________________

Date Worked:__________________________ Area/Floor:_______________

SHIFT:

Total Hours Worked:______________________________________________

Time In:_________ Time Out: _________ Meal: (0 min) (30 min) (60 min)

Overtime Approved:

Yes

I certify that the hours shown above are my total hours worked

and they were properly verified by the facility or its authorized

representative. I also agree that I was not injured on the above shift,

nor have I received any damages while I was working the above shift.

______________________________________________________________

Employee Signature

Date Signed

Facility agrees not to employ directly in any capacity the person named

hereon without first providing at least ninety (90) days written notice

following the termination of this assignment. I certify that the hours

shown above are correct and that the employee performed satisfactory.

Eligible to Return:

Yes

______________________________________________________________

Signature of Facility Representative

Date Signed

Please fax timeslips at the end of your shift in order to have your checks ready.

White - Employer

Yellow - Facility

Pink - Employee

PH 210-340-2988

FX 1-866-810-6625

Employee Time Sheet