Mrci Time Sheet - Mrci Worksource printable pdf download

Mrci Time Sheet - Mrci Worksource

Agency with Choice

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MRCI-CDS Time Sheet

Email to:

Please PRINT using black ink

_____________________

Employee #

for office use only

Employee’s Name: ________________________________________

Client’s Name:

County

Client Representative:

Daytime Phone #

2-Week Pay Period: Sun:

Sat:

Was the Client hospitalized during this

pay period? Yes

(mm/dd/year)

If yes, dates hospitalized________________

You cannot bill for any hours in any day that

the Client is hospitalized

From

Date

Hours

Total Hours

am/pm

Hourly rate: $ ______________________

Totals for the pay period

The hours recorded above are accurate and complete for the period indicated.

Signature of Employee

Signature of Client/Representative

Not valid unless signed by both Parties

**If hours exceed 40 in a calendar week (Sunday thru Saturday), the resulting overtime may be reportable to the County**

FOR OFFICE USE ONLY: Total wages = ____________________

September 2011

P.P.E. _____________

___% of TW = ___________________

___ Spreadsheet

Total =

12/21/2016

Mrci Time Sheet - Mrci Worksource