____________________________________
Name
| Week of: _______________________________ | Week of: _______________________________ |
| Sunday Date: _________ Hours: _________ | Sunday Date: _________ Hours: _________ |
| Monday Date: _________ Hours: _________ | Monday Date: _________ Hours: _________ |
| Tuesday Date: _________ Hours: _________ | Tuesday Date: _________ Hours: _________ |
| Wednesday Date: _________ Hours: _________ | Wednesday Date: _________ Hours: _________ |
| Thursday Date: _________ Hours: _________ | Thursday Date: _________ Hours: _________ |
| Friday Date: _________ Hours: _________ | Friday Date: _________ Hours: _________ |
| Saturday Date: _________ Hours: _________ | Saturday Date: _________ Hours: _________ |
| _____________________________________ | |
| Total Hours | |
| _____________________________________ | _____________________________________ |
| Supervisor Signature | Contractor Signature |
Please fax by Monday 5:00p.m. after the close of the payroll period
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