Extra Duty Report
This form must be submitted by the 12th of each month, for payment on or about the 27th of each month.
Full Name *
Your answer
Mailing Address(street or PO box, city, state, zip)
Your answer
Email *
Your answer
Extra Duty Assignment *
Your answer
Date *
MM
/
DD
/
YYYY
Start Time *
Time
:
End Time *
Time
:
Total Hours Worked *
Your answer
Rate of Pay
Your answer
Total Amount Claimed
Your answer
Submit
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