Volunteer Hourly Time Record
Human Resources
AE 351
650-3774 MS-5221

 
Volunteer's Name: Social Security No.
INSTRUCTIONS: Volunteers of the university are to maintain an hourly time record for the purpose of state medical aid benefits requirements.
ROUTING OF FORM: Submit to department the last working day of the month.

DATE
MO/DA/YR
TYPE OF WORK DONE TIME
STARTED
TIME
ENDED
TOTAL
TIME
DATE
MO/DA/YR
TYPE OF WORK DONE TIME
STARTED
TIME
ENDED
TOTAL
TIME

REPORT TOTAL TIME TO NEAREST TENTH OF AN HOUR (EXAMPLE: 21.2) TOTAL TIME:

VOLUNTEER CERTIFICATION: Volunteer has performed services of her/his own free choice, receives no wages, and has been accepted as a volunteer and assigned or authorized duties by the department.

Volunteer's Signature:
Department:
Authorized Departmental Signature: