New England Joint Board, UNITE

 

Lost Time Form

 

Please print. Fill out completely to speed reimbursement, attach all receipts. Sign at the bottom.

FORMS MUST BE SUBMITTED TO THE OFFICE BY FRIDAY IN ORDER TO BE PAID BY THE FOLLOWING WEEK!

 

 

Name: ___________________________________ _______________

Local Number:__________________________________

Address:__________________________________

Hourly Wage:

___________________________________

SSN:__________________________

Birthday: __________________

Activity Type (circle one):

Negotiations          Joint Board Meeting            E-Board Meeting

 

Other, describe: ________________________________________

 

Organizing: Probe         Blitz         Campaign            First Contract

 

Name of campaign: ___________________________________

 

 

Date: /

Item

Sun

Mon

Tues

Wed

Thurs

Fri

Sat

TOTAL

# hours (regular)

 

 

 

 

 

 

 

 

Per Diem

 

 

 

 

 

 

 

 

Expenses (list each item and attach receipts)

 

 

 

 

 

 

 

 

# miles

driven

 

 

 

 

 

 

 

 

Subtotal

 

 

 

 

 

 

 

 

 

 

____________________________________                   __________________________________

signature of individual           date                                                 approval signature                 date

(Member)                                                                                           (BA, Organizer, Manager)

**If you are regularly scheduled to work Over Time, list the number of hours to be paid at time & a half.

 

Boston Office Fax: 1-617-426-1653