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M ASSACHUSETTS COLLEGE OF ART AND DESI G N
PER DIEM / TRUST FUND TIME SHEET
This form must be filled o u t in b lue p e n. F or m s filled out in pencil w ill not be p r ocessed.
This form should be used by per diem/Trust Fund employees.
SELECT ONE Student/school year - CCCC5 Student/school break – CCC05 Contractor - CCC09
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Name (Ple a s e Print) D e p a r t ment Name
__________________________________________________ __ __ - __ __ __ - __ __ __ __ - 9 - CCC __ __
Empl o yee Payroll ID # G L Trust Fund Accoun t Number
(DO NOT ENTER SOCIAL SECURI T Y # OR BADGE#)
WEEK ENDING WEDNESDAY WEEK END I NG WEDNE S DAY
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WEEKL Y TOTA L HRS _________________ WEE K L Y TOTA L HRS _________________
TOTAL HOURS ON SHEET _________________ HOURL Y WAG E $ ___________________
I certify that I worked the hours posted on the a b ove sheet.
______________________________________________ A d dress Change: Yes N o __
EMPLOYEE SIGNA T U R E D A TE I f yes, please attach the address change form
ACCEPTANCE OF SE RV I CE: I certify t hat servic e s were render e d during the hours posted above.
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SUPERVISOR S I GNATURE DATE
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DEPARTME N T AUTHOR IZ AT I ON DATE
DO NOT WRITE BELOW THIS LINE - FOR HUMAN RESOU R CES USE ONLY:
TOTAL APP R O V ED HOURS ______________
HOURL Y W A GE $_____________________
TOTAL $______________________
Revised 0 6/29/2017