Fidelity National Information Solutions - MLS Division

Time Sheet / Benefit Record
Employee: Griffin, Mario Employee # : Pay Period Ending: 2/15/2009 WEEK #1
Day Monday Tuesday Wednesday Thursday Friday Saturday Sunday 2/1/2009 Total Week #1 Regular Hours Overtime Hours Sick Vacation Other Date In Out
$

County / Dept.: QA

Regular Hours

Overtime Hours

Sick

Vacation

Other

EXEMPT NON-EXEMPT

Explanation of Benefit payments and adjustments to hours worked

WEEK #2
Day Monday Tuesday Wednesday Thursday Friday Saturday Sunday Date 2/2/2009 2/3/2009 2/4/2009 2/5/2009 2/6/2009 2/7/2009 2/8/2009 Total Week #2 In x x x x x Out Explanation of Benefit payments and adjustments to hours worked

8.00 8.00 8.00 8.00 8.00

40.00 Regular Hours

Overtime Hours Sick

Vacation

Other

-

WEEK #3
Day Monday Tuesday Wednesday Thursday Friday Saturday Sunday Date 1/9/2009 1/10/2009 1/11/2009 1/12/2009 1/13/2009 1/14/2009 1/15/2009 Total Week #3 Grand Total In x x x x x Out Explanation of Benefit payments and adjustments to hours worked

8.00 8.00 8.00 8.00 8.00

40.00
80.00

Employee signature:

Date:

Manager signature:

Date: