Form Page: Time

GENERAL INFORMATION

WAIVER STAFF

Employee
ID#

Name

WAIVER RECIPIENT

Email Address

Time Out

ID #

DATE & RATE

Name

(Do
NOT
Change!)

THIS IS
TODAY'S DATE:

# IN GROUP

RATE

TIME SHEET

Date Shift
Began

This date should only need to be changed if
you have worked an overnight shift and are
completing this time sheet the next morning.

YYYY-MM-DD

Time In

HOURS
WORKED

FOR SECOND PART OF OVERNIGHT SHIFT ONLY
(i.e. midnight until end of shift)

This date should not need changed.

Time Out

MIDNIGHT

Time In

HOURS
WORKED

SUMMARY

TOTAL HOURS
WORKED

Signature

Easterseals 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 worked these exact hours with the Waiver Recipient named above.

Enter
Electronic
Signature