Form Page: Sick

GENERAL INFORMATION

WAIVER STAFF

Employee
ID#

Name

Note: Vacation and sick leave may only be used for shifts you are actually scheduled to work and requires your supervisor's consent.

WAIVER RECIPIENT I WAS SCHEDULED TO WORK WITH

Email Address

ID #

WEEK & RATE

Name

(This sets all dates below.
Only change dates here!)

Friday's Date - First Day of Work Week

YYYY-MM-DD

WEEK OF:

TIME SHEET

FRIDAY

RATE

Do not change date.

Sick

Vacation

Do not change date.

SATURDAY

Sick

Vacation

Do not change date.

SUNDAY

Sick

Vacation

Do not change date.

MONDAY

Sick

Vacation

TUESDAY

Do not change date.

Sick

Vacation

WEDNESDAY

Do not change date.

Sick

Vacation

THURSDAY

Do not change date.

Sick

Vacation

SUMMARY

TOTAL HRS SICK

Signature

Easter Seals requires that you certify your time sheet by submitting an electronic signature. To certify your time sheet (1) read the statement below (2) provide an electronic signature (type your name) and (3) click Confirm Signature.

I certify that my time sheet is accurate and true...that I was scheduled to work and took supervisor approved leave.

TOTAL HRS VACATION

Enter
Electronic
Signature