Special Consultant Timesheet

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Special Consultant Timesheet
First Name
Middle Initial
Last Name
(Type or print name as it appears on Social Security Card)
Social Security Number
Department
Pay Period (MO/YR)
DATES OF WORK
Place an X to the right of the appropriate dates of work
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I certify that I have performed the duties as
I certify that the above individual has completed
outlined in the Special Consultant Agreement Form
the assignment as outlined in the Special
and have completed all necessary employment
Consultant Agreement Form in a satisfactory
forms.
manner.
Employee’s Signature
Date
Supervisor’s Signature
Date
DEPARTMENT USE ONLY:
Daily Rate:
Number of Days Paid:
Total Pay Due:
x
=
$
Pay from position #
-
-
-
__
Completed by: ___________________________ Phone: __________________ Date: ____________
PAYROLL OFFICE USE:
Issue Date: _______________
Date Keyed:_______________
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