Employee/Referral Time Card

Instructions: This form can act as an invoice if you are a subcontractor OR as a time card if you are an employee. You agree to submit to Crunch Care an time card online within 24 hours of your shift scheduled. Should the time submittal vary from your booking confirmation please indicate so as requested below and have Client sign at the end of your shift.

PAYMENT: If you are a Referral you can expect to receive your payment via Venmo or requested service/check within 7 business days of your submittal OR if you are an Employee visit the payroll calendar on our site. There are no exceptions to this rule.

Employee or Referral Name:*
Client Serviced Name:*
Bright Horizons Case Number If Applicable for Time Change
Pay (hourly or flat)*
If hourly or flat rate please indicate amount per hour or shift here.
Shift*
Start Time*
End Time*
Regular Hrs. Worked OR Flat Shifts Worked*
Overtime Hrs.
Skip if not applicable due to flat rate. Overtime does not apply for private client cases as you are independently employed and responsible for your own taxes. Please skip this box if a private client case. California Law-Anything over 8 hours in a day and 40 hours in a week time and a half, anything over 12 hours in a day double time New York Law-Anything over 40 hours in a week time and half
The signatory declares under penalty of perjury that the hours reported above are true,accurate, complete and correct. Employee/Referral agrees that he or she has adhered to all Crunch Care’s policies and adhered to all terms of his or her Employee/Referral Agreement with Crunch Care.
Client Signature
This field is to be used when there is a modification from the booking confirmation hours. Client family understand this acts as an electronic signature. It is required ONLY if there is a change. Care Provider CAN NOT sign for a Client.
Care Provider Signature*
This field is to be used as an electronic signature due to either a standard time care signature or an amendment on an existing case.
Hours Modification
- My hours were modified from my booking confirmation.
Please check this box if the hours differ from those that were sent to you on your booking confirmation.
Date*

Date of Signature.

Employee/Referral Time Card

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