United Medical Staffing, Inc.
109 South College Rd - Lafayette, LA
Date at Start of Shift #1
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Month
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Day
Year
Date
Time in and Out of Shift #1
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Hour
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Minutes
AM
PM
AM/PM Option
Until
until
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:
Hour
00
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Minutes
AM
PM
AM/PM Option
Date at Start of Shift #2
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Month
-
Day
Year
Date
Time in and Out of Shift #2
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:
Hour
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58
59
Minutes
AM
PM
AM/PM Option
Until
until
1
2
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5
6
7
8
9
10
11
12
:
Hour
00
01
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03
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59
Minutes
AM
PM
AM/PM Option
Date at Start of Shift #3
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Month
-
Day
Year
Date
Time in and Out of Shift #3
1
2
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10
11
12
:
Hour
00
01
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48
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50
51
52
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54
55
56
57
58
59
Minutes
AM
PM
AM/PM Option
Until
until
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
01
02
03
04
05
06
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59
Minutes
AM
PM
AM/PM Option
Date at Start of Shift #4
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Month
-
Day
Year
Date
Time in and Out of Shift #4
1
2
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10
11
12
:
Hour
00
01
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46
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48
49
50
51
52
53
54
55
56
57
58
59
Minutes
AM
PM
AM/PM Option
Until
until
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
01
02
03
04
05
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56
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58
59
Minutes
AM
PM
AM/PM Option
Date at Start of Shift #5
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Month
-
Day
Year
Date
Time in and Out of Shift #5
1
2
3
4
5
6
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9
10
11
12
:
Hour
00
01
02
03
04
05
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42
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44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
Minutes
AM
PM
AM/PM Option
Until
until
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
01
02
03
04
05
06
07
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09
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58
59
Minutes
AM
PM
AM/PM Option
TOTAL HOURS WORKED
Additional Comments (explanation of overtime)
*
Name
*
First Name
Last Name
Nurse Personal Email:
*
example@example.com
Submit
Should be Empty: