Week 1
Day In Out Unpaid breaks (min) Rate that day Hours
Sun Oct 25
Clock in, Sun Oct 25
Clock out, Sun Oct 25
Unpaid breaks (min), Sun Oct 25
Rate that day, if different, Sun Oct 25
–
Mon Oct 26
Clock in, Mon Oct 26
Clock out, Mon Oct 26
Unpaid breaks (min), Mon Oct 26
Rate that day, if different, Mon Oct 26
–
Tue Oct 27
Clock in, Tue Oct 27
Clock out, Tue Oct 27
Unpaid breaks (min), Tue Oct 27
Rate that day, if different, Tue Oct 27
–
Wed Oct 28
Clock in, Wed Oct 28
Clock out, Wed Oct 28
Unpaid breaks (min), Wed Oct 28
Rate that day, if different, Wed Oct 28
–
Thu Oct 29
Clock in, Thu Oct 29
Clock out, Thu Oct 29
Unpaid breaks (min), Thu Oct 29
Rate that day, if different, Thu Oct 29
–
Fri Oct 30
Clock in, Fri Oct 30
Clock out, Fri Oct 30
Unpaid breaks (min), Fri Oct 30
Rate that day, if different, Fri Oct 30
–
Sat Oct 31
Clock in, Sat Oct 31
Clock out, Sat Oct 31
Unpaid breaks (min), Sat Oct 31
Rate that day, if different, Sat Oct 31
–
Week 1 bonus ($, optional) Production, attendance or shift bonuses you were promised for this week. Not gifts or holiday pay.
Week 2
Day In Out Unpaid breaks (min) Rate that day Hours
Sun Nov 1
Clock in, Sun Nov 1
Clock out, Sun Nov 1
Unpaid breaks (min), Sun Nov 1
Rate that day, if different, Sun Nov 1
–
Mon Nov 2
Clock in, Mon Nov 2
Clock out, Mon Nov 2
Unpaid breaks (min), Mon Nov 2
Rate that day, if different, Mon Nov 2
–
Tue Nov 3
Clock in, Tue Nov 3
Clock out, Tue Nov 3
Unpaid breaks (min), Tue Nov 3
Rate that day, if different, Tue Nov 3
–
Wed Nov 4
Clock in, Wed Nov 4
Clock out, Wed Nov 4
Unpaid breaks (min), Wed Nov 4
Rate that day, if different, Wed Nov 4
–
Thu Nov 5
Clock in, Thu Nov 5
Clock out, Thu Nov 5
Unpaid breaks (min), Thu Nov 5
Rate that day, if different, Thu Nov 5
–
Fri Nov 6
Clock in, Fri Nov 6
Clock out, Fri Nov 6
Unpaid breaks (min), Fri Nov 6
Rate that day, if different, Fri Nov 6
–
Sat Nov 7
Clock in, Sat Nov 7
Clock out, Sat Nov 7
Unpaid breaks (min), Sat Nov 7
Rate that day, if different, Sat Nov 7
–
Week 2 bonus ($, optional) Production, attendance or shift bonuses you were promised for this week. Not gifts or holiday pay.
Two shifts on one day? Put the first clock-in and the last clock-out, and the gap between them as an unpaid break. A shift past midnight belongs to the day it started.