Payroll Entry – Marketing – Valley Regional Home Health

1 Regular Hours

2 Overtime and Vacation

3 Expense Reimursement

4 Bonus Marketing

Division*
Name*
First Last
Pay Period*
Enter Hours
Please note:
1. All break times should be entered in minutes, not hours
2. Timesheet needs to be complete and filled out accurately for payroll to process
3. Leave fields blank for the days you were OFF
1st Day of the Month
Shift Start Time

: HH

MM
Shift End Time

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MM
Total Break Minutes
2nd Day of the Month
Shift Start Time

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Shift End Time

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3rd Day of the Month
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Total Break Minutes
4th Day of the Month
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Total Break Minutes
5th Day of the Month
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6th Day of the Month
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Total Break Minutes
7th Day of the Month
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Total Break Minutes
8th Day of the Month
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Total Break Minutes
9th Day of the Month
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Total Break Minutes
10th Day of the Month
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Total Break Minutes
11th Day of the Month
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12th Day of the Month
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13th Day of the Month
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Total Break Minutes
14th Day of the Month
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Total Break Minutes
15th Day of the Month
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Total Break Minutes
16th Day of the Month
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Total Break Minutes
17th Day of the Month
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Total Break Minutes
18th Day of the Month
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Total Break Minutes
19th Day of the Month
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Total Break Minutes
20th Day of the Month
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Total Break Minutes
21st Day of the Month
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Total Break Minutes
22nd Day of the Month
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Total Break Minutes
23rd Day of the Month
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Total Break Minutes
24th Day of the Month
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Total Break Minutes
25th Day of the Month
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Total Break Minutes
26th Day of the Month
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Total Break Minutes
27th Day of the Month
Shift Start Time

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Total Break Minutes
28th Day of the Month
Shift Start Time

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Shift End Time

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Total Break Minutes
29th Day of the Month
Shift Start Time

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Shift End Time

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Total Break Minutes
30th Day of the Month
Shift Start Time

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Shift End Time

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Total Break Minutes
31st Day of the Month
Shift Start Time

: HH

MM
Shift End Time

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MM
Total Break Minutes
Please enter your hours into the timesheet before continuing

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Overtime and Vacation
Did you work overtime for this pay period?
- No
- Yes
How many hours?
Use decimals if needed for partial hours (e.g., 1.5 hours)
Are you requesting any sick hours for this pay period?
- No
- Yes
How many hours?
Use decimals if needed for partial hours (e.g., 1.5 hours)
Were you on paid vacation for this pay period?
- No
- Yes
Enter Requested Vacation Dates
Was your vacation approved?
- No
- Yes
By Whom?

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Expense Reimbursement
Expense 1 Date
Date Format: MM slash DD slash YYYY
Expense 1 Account
Expense 1 Amount
Expense 2 Date
Date Format: MM slash DD slash YYYY
Expense 2 Account
Expense 2 Amount
Expense 3 Date
Date Format: MM slash DD slash YYYY
Expense 3 Account
Expense 3 Amount
Expense 4 Date
Date Format: MM slash DD slash YYYY
Expense 4 Account
Expense 4 Amount
Expense 5 Date
Date Format: MM slash DD slash YYYY
Expense 5 Account
Expense 5 Amount
Expense 6 Date
Date Format: MM slash DD slash YYYY
Expense 6 Account
Expense 6 Amount
Expense 7 Date
Date Format: MM slash DD slash YYYY
Expense 7 Account
Expense 7 Amount
Expense 8 Date
Date Format: MM slash DD slash YYYY
Expense 8 Account
Expense 8 Amount
Expense 9 Date
Date Format: MM slash DD slash YYYY
Expense 9 Account
Expense 9 Amount
Expense 10 Date
Date Format: MM slash DD slash YYYY
Expense 10 Account
Expense 10 Amount
Expense 11 Date
Date Format: MM slash DD slash YYYY
Expense 11 Account
Expense 11 Amount
Expense 12 Date
Date Format: MM slash DD slash YYYY
Expense 12 Account
Expense 12 Amount
Expense 13 Date
Date Format: MM slash DD slash YYYY
Expense 13 Account
Expense 13 Amount
Expense 14 Date
Date Format: MM slash DD slash YYYY
Expense 14 Account
Expense 14 Amount
Expense 15 Date
Date Format: MM slash DD slash YYYY
Expense 15 Account
Expense 15 Amount
Total Expenses
Upload scanned receipts
Drop files here or

Accepted file types: jpg, pdf, png, bmp, tif.
Total Miles Driven for Work

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Bonus Fundraising
Dollars Raised
Period
Bonus Marketing
Home Health Referrals - Medicare only
Hospice Referrals - Medicare only
Total Referrals
All Medicare referrals
- All Medicare referrals
All open to services
- All open to services
None are resumptions and have been discharged from Agency for a minimum of 30 days
- None are resumptions and have been discharged from Agency for a minimum of 30 days
Total Other Insurance Referrals
Do you have any questions or concerns that you wish to discuss with:
- Arman Zakaryan
- Mari Zakaryan
Please enter your question or concern
Certification*
- I certify that the information entered into this form is accurate.
Name
This field is for validation purposes and should be left unchanged.

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Payroll Entry – Marketing

Enter Hours

1st Day of the Month

2nd Day of the Month

3rd Day of the Month

4th Day of the Month

5th Day of the Month

6th Day of the Month

7th Day of the Month

8th Day of the Month

9th Day of the Month

10th Day of the Month

11th Day of the Month

12th Day of the Month

13th Day of the Month

14th Day of the Month

15th Day of the Month

16th Day of the Month

17th Day of the Month

18th Day of the Month

19th Day of the Month

20th Day of the Month

21st Day of the Month

22nd Day of the Month

23rd Day of the Month

24th Day of the Month

25th Day of the Month

26th Day of the Month

27th Day of the Month

28th Day of the Month

29th Day of the Month

30th Day of the Month

31st Day of the Month

Overtime and Vacation

Expense Reimbursement

Bonus Fundraising

Bonus Marketing

Submit Referral