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Child Care Reimbursement Form - COVID-19 (HR)

Oct 27, 2022
submission #286
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Employee Information

Employee Name ---
Employee number (4 digits, same as on your timesheet) ---
Email (for questions) ---
Phone number (for questions) ---
Department name Community Safety Department
Division name Public Safety
Employee's Direct Supervisor (could be a Supervisor, Manager, or Director) ---
Today's date ---

Child Care Receipts

Date on which child care was provided - 1 ---
Reimbursement request (up to $50) - 1 ---
Receipt - 1 ---
Date on which child care was provided - 2 ---
Reimbursement Request (up to $50) - 2 ---
Receipt - 2 ---
Date on which child care was provided - 3 ---
Reimbursement Request (up to $50) - 3 ---
Receipt - 3 ---
Date on which child care was provided - 4 ---
Reimbursement Request (up to $50) - 4 ---
Receipt - 4 ---
Date on which child care was provided - 5 ---
Reimbursement Request (up to $50) - 5 ---
Receipt - 5 ---