Civil Service Form 48 Employee No.

____________ Official or Employee

DAILY TIME RECORD

(NAME)

For the Month of_________________ 200__

Official Hours for Reg. Days

____________________
Arrival and Departure Saturdays
_________________
D A.M. P.M. OVERTIME
A
Y Arr Dep. Arr. Dep. Arr.Dep.
.
1

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

TOTAL _______________________

I certify on my honor that the above

is true and correct report of the hours of
work performed, record of which was made
daily at the time of arrival
and departure from office.
Civil Service Form 48 Employee No. 12

____________ 13

14

DAILY TIME RECORD 15

16

17

(NAME) 18

19
For the Month of _________________ 20
200__
21

22
Official Hours for Reg. Days 23
____________________
24
Arrival and Departure Saturdays 25
_________________
26
D A.M. P.M. OVERTIME 27
A
Y Arr Dep. Arr. Dep. Arr.Dep. 28
. 29
1
30
2
31
3
TOTAL _______________________
4

6 I certify on my honor that the above

7 is true and correct report of the hours of

work performed, record of which was made
8
daily at the time of arrival
9
and departure from office.
10

11

Official or Employee
VERIFIED as to the prescribed hours. VERIFIED as to the prescribed
hours.