Contact payroll with questions: firstname.lastname@example.org
Complete a separate form for each week.
UP ID Number: _______________ __ Organization Number: _______ ___
Name: _____________________________ Hourly Rate/Pay Amount: _____________
Position Number: ____________________ Pay Period:
*The late timesheet will be processed and paid within 10 days of receipt or added to the next
regular payday, whichever occurs first*
Please provide a reason for why the above hours were not entered electronically
Employee did not record time on SSB:
Employee Signature: Date:
Your signature certifies that this information is accurate and complete.
Supervisor Name: Supervisor Signature: Date: Ext:
I certify that the above hours reported are actual hours worked, true and accurate.
* I understand that proper and timely reporting of my hours is a job expectation. A recurring failure to
do so may result in disciplinary action up to, and including termination.
click to sign
click to edit