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ITY PHONE EMPLOYEE NAME SOCIAL SECURITY NUMBER EMPLOYEE SIGNATURE IMPORTANT FOR EMPLOYEE: By execution of this form, employee agrees to terms and conditions on next page and certifies that this form is true, accurate, complete, and that no injuries were suffered during the work performed. HOURS TO NEAREST QUARTER HOUR DAY DATE STARTED FINISHED LESS LUNCH REG HOURS OT HOURS MON TUES WED THUR FRI SAT SUN REGULAR HRS CLIENT: PLEASE WRITE TOTAL HOURS IN WORDS TO THE NEAREST QUARTER HOUR.
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