Employee Name Employee Title Employee Number SALARY
HOURLY
Pay Period from: to Pay Day:
Pay Grant
Sun Mon Tue Wed Thu Fri Sat Sun Mon Tue Wed Thu Fri Sat Bi-Weekly
Code Code
Subtotal
HR Total: OT Total: HOL Total:
PTO Total: LWP Total: Other Total: Pay Period Total:
Employee signature: Date: / /2016
Supervisor signature: Date: / /2016