MEDICAL LEGAL INFORMATION TECHNOLOGY OFFICE
EMPLOYEE TIMESHEET
Employee Name Client
Social Security # (Last four) XXX-XX- Week ending
I certify that I have worked the hours listed on this timesheet. Job request number
Employee Signature
Fax to (202) 639-9630
I would like: My check mailed to me To pick up my check at Proxy Personnel Direct deposit
INSTRUCTIONS
• Fill out timesheet each day and round off your hours to the nearest quarter hour
• This timesheet must be signed by your supervisor at the end of the week or at the end of your
assignment, which ever occurs first
• Overtime is any time over 40 hours per week. Overtime must be pre-approved by the Client and Proxy
Personnel. The Client must demonstrate approval of overtime by initialing the overtime approval box
• Be sure to fill out the timesheet completely
• Time sheet must be returned no later than noon on Monday following the end of the week
Day Date Time In Time Out Less Break Total Hours
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Total Regular Hours Overtime Initial
Total Overtime Hours
CLIENT AGREEMENT
In consideration for the services provided to us by Proxy Personnel, we hereby agree as follows: 1) Client agrees that the
above hours are correct, 2) this timesheet is subject to the terms and conditions of the Client Agreement between Client and
Proxy Personnel and is binding on Client, subsidiaries, divisions, or associated or related entities, 3) Client agrees not to
employ the above named individual without prior express written consent from Proxy Personnel, and 4) Client agrees to be
responsible for reasonable attorney fees incurred in enforcing the terms of this agreement.
CLIENT NAME (Please Print) CLIENT SIGNATURE
1100 H Street, NW ● Suite 260 ● Washington, DC 20005 ● Tel: 202.639.9300 ● Fax: 202.639.9630 ● www.ProxyPersonnel.com