WORKERS HEALTH CARE WORKERS HEALTH CARE

General Santos City General Santos City

C.S. FORM NO. C.S. FORM NO.

DAILY TIME RECORD DAILY TIME RECORD

JORAND T. FACURIB
(NAME) (NAME)
For the month of ___________________________________ For the month of _____________________________________
Aug. 1-15, 2010
Official hours for (Regular days Monday to Friday) Official hours for (Regular days Monday to Friday)
Arrival and Departure: 8:00 AM to 5:00 PM _________ Arrival and Departure: 8:00 AM to 5:00 PM _________
DAY A M P M DAY A M P M
Arrival Departure Arrival Departure Total Arrival Departure Arrival Departure Total
1 1 Sunday
2 2 8:10 5:10 9
3 3 8:05 5:05 9
4 4 8:05 5:05 9
5 5 8:05 5:05 9
6 6 8:10 5:10 9
7 7 10:00 3:00 5
8 8 Sunday
9 9 8:05 5:05 9
10 10 8:10 5:10 9
11 11 8:10 5:10 9
12 12 8:05 5:05 9
13 13 8:05 5:05 9
14 14 10:00 3:00 5
15 15 Sunday
16 16
17 17
18 18
19 19
20 20
21 21
22 22
23 23
24 24
25 25
26 26
27 27
28 28
29 29
30 30
31 31
Total Hrs. Total Hrs. 100
Total Days Total Days 12.5
I certify on my honor that the above is true and correct I certify on my honor that the above is true and correct
report on the hours of performed record of which was made report on the hours of performed record of which was made
daily at the time of arrival and departure from office. daily at the time of arrival and departure from office.

Employee Employee

VERIFIED as to the prescribed office hours. VERIFIED as to the prescribed office hours.

Approved by: Approved by:

GEORGE C. TAPEL GEORGE C. TAPEL

Chief Executive Officer Chief Executive Officer
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