Phone: (702) 878-7505 Email: [email protected]

Committee Time Reimbursement Form

Committee Time Reimbursement Form

Local No. 1285 502 S. Ninth Street Las Vegas, NV 89101-7011 702-878-7505

Instructions:

Please complete all sections marked with a red asterisk. Please note, committee time will be paid on a monthly basis, on or around the first of the month. Please don't forget your mailing address, and to submit the form when done. If you have any questions or comments please contact your union treasurer. Thank you for your time and work!
Member receiving committee time pay.
Please input your mailing address
Please select from the following
By placing your name here, you are signing this Form electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Form. You declare under penalty of perjury that this claim has been examined you and to the best of your knowledge, believe it to be a true and correct.
Please provide your email address Must be a valid e-mail address, e.g. [email protected]

Dates and Hours Worked

Please input the number of hours worked for each day directly below the date box. If more than four(4) dates are needed, please submit a second Committee Time Reimbursement Form.

Please input the date mm/dd/yy.
Please input the date mm/dd/yy.
Please input the date mm/dd/yy.
Please input the date mm/dd/yy.
Please use half hour increments.
Please use half hour increments.
Please use half hour increments.
Please use half hour increments.
Note: * indicates required information.
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