PITMAN BOARD OF EDUCATION
SALARY STATEMENT AND REQUEST FOR PAYMENT
| Dates Worked | Work Performed | Time In | Time Out | Hours | |
|---|---|---|---|---|---|
| TOTAL NUMBER OF HOURS | 0.00 | ||||
Signature of Employee
Date
Approved by (Signature)
Date
TO BE COMPLETED BY BUSINESS OFFICE
Hours, rate, account coding, and totals below are for business office use.
| No. of Hours | Amount $ (Rate) | Total | Account Number | |
|---|---|---|---|---|
| 0.00 | GRAND TOTAL $ 0.00 | |||