CDS STAFF MILEAGE & ACTIVITY REIMBURSEMENT VERIFICATION CLIENT’S NAME

3 STAFF WORKING PAPER ERSD200405 AUGUST 2004
CODE OF CONDUCT FOR OUR COACHING STAFF COACHES
CUSTOMER SERVICEOFFICE STAFFRESERVATIONSDISPATCH TRAINING BEYOND “HELLO” (BOOK) BEYOND

HOSPITAL MEDICAL STAFF POLICY SUBJECT DISRUPTIVE BEHAVIOR
HUMAN RESOURCES POLICY STATEMENT HRPS9 STAFF STUDYING
HUMAN RESOURCES RECORDS STAFFING RECORDS INVOLVING STAFF POSITIONS

CDS Staff Mileage and Activity Reimbursement (DAK 7113)


CDS STAFF MILEAGE & ACTIVITY REIMBURSEMENT VERIFICATION


CLIENT’S NAME

     


EMPLOYEE’S NAME

     


MONTH/YEAR

     

MILEAGE REIMBURSEMENT RATE

     


DATE

# OF MILES TRAVELED

STAFF EXPENSES

(Attach receipts)

AMOUNT PAID

CHECK NUMBER

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

TOTALS

     


     



The miles and activity reimbursements recorded above are accurate and complete for the period indicated.



Signature of Employee Date


Signature of Client/Parents/Guardian Date




PAGE 2 TO BRANCH MANAGERS AND STAFF FROM
PROFESSIONAL STAFF CSOPERT CONTRACT VENDOR SEARCH &
RECORD OF OBSERVATION OF TEACHING FOR ALL STAFF


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