Temporary Employment Hours Tracking Log
This information is only for capturing HISTORICAL employment hours, not for budgeting income.
CSO NUMBER
PARENT’S NAME
EMPLOYMENT
DATE(S)
JAS ID
NAME OF EMPLOYER
CONTACT NAME/TITLE AND
PHONE NUMBER
DATE VERIFIED
AND DATE NOTE
ENTERED
IN E-JAS
CLIENT ID
TOTAL
NUMBER
OF HOURS
WORKED
HOW VERIFIED
(PHONE, TEMP
EMPLOYMENT
FORM, PAY STUBS)
REPORT MONTH
STAFF PRINTED NAME/SIGNATURE
This information is only for capturing historical employment hours, not for budgeting income.
DSHS 02-586 (05/2009)