We need help to make to improve our Website Time Card

Our website is built on WordPress.

We have up to 100 remote employees who want to submit time cards to us. Presently they fill out the attached and then have their supervisor sign who then in turn either mails it or faxes it to us. Our objective would be to rationalise this by having a page on the website where they could enter the following-

Employee Name
Client Name
Report To:

Hours worked to be defined as hours as well as minutes (minutes in 15 minute intervals)

Based upon the hours entered the script would calculate the Total Hours of the Week.

The possible entries for "hours" would be 1- 12 AM/PM
The possible entries for "minutes would be 0,15,30,45

Hours/minutes would want to be entered for (I) Start (ii) Break Out (iii) Break In (iv) End

When completed we then want the ability for the user to print out the actual time card on their printer.

Desired Skills are PHP, WordPress, PHP5, PHP4