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["様式10号"]
["勤務実績通知書／派遣元への通知書"]
["令和   年  月分 (   月   日～   月    日)"]
[]
["　　　公益社団法人静岡県シルバー人材センター連合会"]
["　",null,null,null,"                 　　　　　　御中"]
[null,"貴事業所の派遣労働者の勤務実績は下記の通りです。",null,null,null,null,null,null,null,null,null,null,null,null,"派遣先責任者：",null,null,null,null,"㊞"]
[]
[]
["派遣労働者氏名",null,null,null,null,null,"派遣先事業所名",null,null,null,null,null,null,null,null,"就業部署名"]
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["従事した業務の種類（内容）",null,null,null,null,null,null,null,null,null,"就業場所住所"]
[]
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["就業日",null,"始業時刻",null,null,null,"終業時刻",null,null,null,"休憩時間",null,"実働時間数",null,null,null,"本人\n確認印","勤務管理者\n確認印","備考"]
[null,null,"時",null,"分",null,"時",null,"分",null,"分",null,"時間",null,"分"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
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[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"交通費あり"]
[]
["当月合計",null,"勤務日数",null,"日",null,"欠勤日数",null,"日",null,"実　働\n時間数",null,"時間",null,"分"]
[]
["派遣労働者から申出を受けた苦情の処理に関する事項"]
["年月日",null,null,null,"苦情の内容",null,null,null,null,null,null,null,null,null,"苦情の処理"]
["　年　 月 　日"]
["　年　 月 　日"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,"事業所処理欄",null,null,null,null,"事務所長","派遣元責任者","担当者","担当者"]
[null,null,null,null,null,null,null,null,null,null,null,null,"令和　　　年　　月　　日"]