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Final Time Record Certification
By submitting this form, I certify that all time, meal break, rest break, live-in, location, and device-related information provided is true, complete, and accurate to the best of my knowledge. I understand that I am responsible for reporting only the time I actually and actively worked, and for accurately reporting all unpaid meal periods, paid rest breaks, interruptions, corrections, and exceptions.
I certify that I was not forced, pressured, threatened, coached, directed, encouraged, or instructed by any administrator, manager, supervisor, coworker, resident, resident family member, or any other person to submit login time, logout time, meal break information, rest break information, live-in information, or any other time record differently from the time I actually worked and the breaks I actually took.
If any part of my shift, time record, meal period, rest period, live-in sleep time, unpaid meal time, unpaid free time, or location information is inaccurate, incomplete, interrupted, disputed, or requires correction, I have disclosed that information in the notes above before submitting this form.