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1797 Pitkin Avenue Brooklyn, NY 11212         Tel : 5166000122,   Fax : 5166000122

TIME AND ACTIVITY RECORD (DUE EVERY Friday)

Day
SUNDAY
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
Day Date Time Started Time Finished Total Hours
SUNDAY
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY
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Persoanl Tasks
House Hold/VIVIENDA/
  I certify that the supplied information is accurate, the hours shown represent my total hours worked in this assignment during the week and they are properly verified by the participant or authorised repsresentative.

Checks will not be released without completed and signed activity record!

Employee Signature
Client Signature