The form should be filled out on a weekly basis. Once completed and all signatures applied, this form is to be retained in departmental files. Employee Name Enter first and last name. Department Number Enter department number. Leave Period Check the appropriate leave period.
Year Enter the year .
Date End Date Hours Worked Enter the begin date of the work week. Enter the end date of the work week. Enter for each day the number of hours worked. Enter leave usage on days in which leave was used. Date Enter the date the form was completed by the employee.