Business Name:
Emloyee Name:
Supervisor:

Week Ending Saturday

Month (Ex. 03)

Day (Ex. 22)

Year (Ex. 2006)

Please specify times in the following manner.
08:00 AM 12:00 PM 01:00 PM 05:00 PM

	Time In	Time Out	Time In	Time Out	Total
SUN
MON
TUE
WED
THUR
FRI
SAT
Total Straight Hours
Total Overtime Hours

You must type "I AGREE" in this box

I understand that I am to contact Employment Plus, Inc. upon completion of this assignment, and that if I do not do so, Employment Plus may assume that I am not then available for work, and thus are not eligible for Unemployment Benefits.