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Worksite (Required.)

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Employee First and Last Name (Participant worker) (Required.)

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Employee Work Week (in current pay period)

Date
Date

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Employee Hours Worked

  Hours Minutes
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

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Submitter Information (Required.)

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I have reviewed these hours with the employee and verify my submission is true (Required.)

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Is this is a resubmission of previously entered hours? (Required.)

T