CONSUMER:  %consumer_name%  (%consumer_id%)

WEEK OF:  %weekof%

RATE:  %rate%

EMPLOYEE:  %employee_name%  (%employee_id%)

EMAIL:  %email%

FRIDAY  (%date1%)

TUESDAY  (%date5%)

Sick: %fri_sick% Vacation: %fri_vac%

Sick: %tue_sick% Vacation: %tue_vac%

SATURDAY  (%date2%)

WEDNESDAY  (%date6%)

Sick: %sat_sick% Vacation: %sat_vac%

Sick: %wed_sick% Vacation: %wed_vac%

SUNDAY  (%date3%)

THURSDAY  (%date7%)

Sick: %sun_sick% Vacation: %sun_vac%

Sick: %thu_sick% Vacation: %thu_vac%

MONDAY  (%date4%)

SUMMARY

Sick: %mon_sick% Vacation: %mon_vac%

TOTAL SICK: %total_sick%  TOTAL VACATION: %total_vac%

Employee Electronic Signature: %ESignature1%

(I certify that my time sheet is accurate and true...that I worked these exact hours with the Waiver Recipient named above.)

Form Submission Time: %_sfm_form_submision_time_%