Supervisor Signature
Employee Signature
Thursday
Employee certifies that regular, leave taken, and premium hrs. worked is accurate, and is in keeping with Department
regulations.
Supervisor Action and Signature
Time Keeper Signature
Date (mm-dd-yyyy)
Date (mm-dd-yyyy)
Timekeeper Signature
Date (mm-dd-yyyy)
Pay Period:
Tuesday
Monday
Thursday
Wednesday
Monday
Friday
Sunday
Employee Comments
Friday
AL SL CU ND SDLWRD OtherCW
Name
Last First Middle
HPDate Start Time End Time OT
Wednesday
Tuesday
Saturday
Sunday
Saturday
Day
Period Totals:
TIME AND ATTENDANCE 2017
U.S. Department of State
DS-4151
05-2017
TW
Supervisor Action
Supervisor Comments
(Select)
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signature
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signature
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signature
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