WAGE VOUCHER
Wage Voucher Week Ending:
Check Number:
Check Amount:
Member Email:
Pay Rate:
$
(Hourly)
Name:
Night Differential:
Street:
City:
State:
Zip:
Date
MM/DD/YYYY
Office
Hours
Field
Hours
Reason
(Union Business, lost time, office, member call backs, or misc. are no longer acceptable reasons.)
Total
Office + Field
Total (Office Hours)
0.00
Total (Field Hours)
0.00
Total Both Columns (Hours)
0.00
Estimated Gross (Hours × Pay Rate)
$0.00
Voucher must be filled out and signed or it will not be processed. Any incomplete voucher will be returned.
I certify that the hours shown on this voucher were incurred by me on behalf of CWA Local 1123.
Signature:
Date:
Approved by:
Signature:
Title:
Signature:
Title:
Submit Voucher
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