TIME SHEETS

Urgent Medical Staffing Solutions Online Time sheet Submission. 315 west James St. Suite 103A Lancaster PA 17603|P-717-925-1120 | F- 717-326-1395 | payroll@umssrf.com.

Employee Name

CLIENT NAME:

LAST FOUR DIGITS OF SOCIAL SECURITY:

DISCIPLINE:

DATE WORKED:

FLOOR/UNIT

DAY OF THE WEEK

SHIFT:

Other

TIME IN:

TIME OUT:

Initials of Client Authorized Representative authorizing NO MEAL BREAK TAKEN.

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COMPLETED BY FACILITY

TOTAL HOURS WORKED:

OVERTIME APPROVED

Yes No

I recognize the rights of Urgent Medical Staffing Solutions, LLC as the employer and agree not to employ directly in any capacity the person named heron without first providing Urgent Medical Staffing Solutions, LLC atleast 90 days written notice following the termination of this assignment. I certify that the hours shown above are correct and that the employee performed satisfactory.

SIGNATURE OF AUTHORIZED CLIENT REPRESENTATIVE
DIGITAL SIGNATURE- USE YOUR FINGER OR STYLUS PEN TO SIGN/DRAW.

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CLIENT REPRESENTATIVE FULL NAME

CLIENT REPRESENTATIVE POSITION

DATE SIGNED:

Email Address:
Enter your email to receive a copy of this timesheet.

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I certify that the hours shown above represent my total hours worked and that they were properly verified by the client or by an authorized representative. I also certify that I was not injured on the above shift.

Employee Signature

Clear

Date

Email Address
Enter your email to receive a copy of your submitted timesheet.

Once you successfully submit time sheet you don't need to do anything else. You will receive a copy of completed time sheet via email. Time sheet will be received by payroll. If You have any questions please call 717-925-1120. Thank You for all you do!