Nursing Home Expense Claim Form
Nursing Home Expense Claim Form
Date: [Month Day, Year]
Please fill out the form with the required information for each expense claim. Attach all relevant receipts to support your claim. In the absence of a receipt, provide a detailed explanation for the expense.
Employee Information
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Employee Name: |
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Employee ID: |
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Department: |
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Position: |
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Claim Submission Date: |
Expense Details
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Description of Expense |
Date |
Amount ($) |
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Medical Gloves |
[Month Day, Year] |
$150.00 |
Certification and Approval
Employee's Signature:
[Name]
[Job Title]
[Month Day, Year]
Finance Department's Approval:
[Your Name]
[Job Title]
[Month Day, Year]
