Child Care Reimbursement Form - COVID-19 (HR)
Mar 30, 2023
submission
#320
Fill in your information
Employee Information
| Employee Name | --- |
| Employee number (4 digits, same as on your timesheet) | --- |
| Email (for questions) | --- |
| Department name | City Managers Department |
| Division name | Urban Design and Architecture Studio |
| 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 | --- |