CJK #
PS # Topic Taught Date Taught
Number
Hours
Course # Ref # Rate
Hours 11270200-56001 11500-IPS-00-56001
$
c:/Debbie/Timesheets/Adj Sup Time Sheet 9/1/16
Director/Designee Signature: ______________________________________ Date: __________________
Procedure 6033, Attachment 4, 081583 Rev: 9/1/16
Print Name: _________________________________________________ PID Number: _________________
Submit Original/Signed Time Sheet to Criminal Justice Training Program office by the last day of the month.
Criminal Justice Training Program Supplemental Time Sheet
Month ________________ 20_______ Term ____________
*$
I hereby certify that the data included herein is correct.
Grand Total
Signature: ___________________________________________ Date: __________________
Total Hours
Enter the Course/Program Name as indicated on schedule (i.e., BLE, BCO, BDD, EOT and the 4 digit
number following).
Enter the topics you taught in the course you indicated.
Enter one date per line.
Enter the number of hours taught for each time period.
The panels below are for Office Use Only
(*Lou, Chasity, Don, Frank)
Course/Program Name: _____________________________________
0