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Unscheduled Hours Timecard
Attestation of Unscheduled Hours Worked
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* Indicates required question
Employee Name
*
Your answer
Date of Unscheduled Hours
*
MM
/
DD
/
YYYY
Start Hours Worked
*
Time
:
AM
PM
End of Hours Worked
*
Time
:
AM
PM
Allocation of Hours Worked
*
Training (Internal to Action Ambulance)
Education (External from Action Ambulance)
Scheduling
Special Detail
Orientation
Salaried Manager Covering Ambulance (outside normal daily schedule)
Other:
Detailed Explanation
*
Your answer
Attestation
*
By checking this box I attest that the answers above are true to the best of my knowledge. Any false information provided in this form may result in disciplinary action up to and including termination.
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