Rx Med Staff, LLC 502 Granberry Humble, Texas 77338 Office: (832) 527-0771 Fax: (281) 596-2714 7214 www.rxmedstaff.com Hospital/Client’s name Employee’s name Social Security # Area date
Dept# time start
Thu Fri Sa
Total hours to nearest ¼ hrs
I certify that the hours shown above are correct and performed satisfactorily. Employee signature:
I certify that the hours shown above are the accurate hours worked and verified by client or by an authorized representative.
Signatue of authorized personnel of Facility ONLY
Published on Feb 21, 2008