Name
Address
Employee's Email
Employee's Phone
Pay Period 1/Sep/16
Pay Rate $ 10.00
# of
# of regular
Date replacement
hours worked
hours
1/Sep/16
2/Sep/16
3/Sep/16
4/Sep/16
5/Sep/16
6/Sep/16
7/Sep/16
8/Sep/16
9/Sep/16
10/Sep/16
11/Sep/16
12/Sep/16
13/Sep/16
14/Sep/16
15/Sep/16
16/Sep/16
17/Sep/16
18/Sep/16
19/Sep/16
20/Sep/16
21/Sep/16
22/Sep/16
23/Sep/16
1
24/Sep/16
25/Sep/16
26/Sep/16
27/Sep/16
28/Sep/16
29/Sep/16
30/Sep/16
1/Oct/16
Employee Signature
2
Total
Comments Total Regular Pay
Replacement Pay
$ - $ -
$ - $ -
$ - $ -
$ - $ -
$ - $ -
$ - $ -
$ - $ -
$ - $ -
$ - $ -
$ - $ -
$ - $ -
$ - $ -
$ - $ -
$ - $ -
$ - $ -
$ - $ -
$ - $ -
$ - $ -
$ - $ -
$ - $ -
$ - $ -
$ - $ -
$ - $ -
3
$ - $ -
$ - $ -
$ - $ -
$ - $ -
$ - $ -
$ - $ -
$ - $ -
$ - $ -
Total Replacement Pay $ -
Total Regular Pay $ -
Total Pay $ -
Date