Employee certifies that regular, leave taken, and premium hrs. worked is accurate, and is in keeping with Department
regulations.
Supervisor Action and Certification
Time Keeper Certification
Date (mm-dd-yyyy)
Date (mm-dd-yyyy)
Date (mm-dd-yyyy)
Pay Period
Employee Comments
AL SL CU ND SDLWRD OtherCW
Name
Last First Middle
HPDate Start Time End Time OT
Saturday
Day
Period Totals:
TIME AND ATTENDANCE 2019
U.S. Department of State
DS-4151
09-2018
TW
Supervisor Action
Supervisor Comments
Thursday
Tuesday
Monday
Thursday
Wednesday
Monday
Friday
Sunday
Friday
Wednesday
Tuesday
Saturday
Sunday
Employee Signature
Time Keeper Signature
Supervisor Signature
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signature
click to edit
click to sign
signature
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click to sign
signature
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