Pay Claim Form

Pay Claim Form
IMPORTANT

To prevent delays to your pay, this form must be completed as soon as possible after the last working day of the month for which you are claiming. Boxes marked with '*' are mandatory. If these are not complete your claim form may be returned to you for completion which could result in delays of any payment.
Name

First NameLast Name
Staff Email
example@example.com
Employee No
i.e. "Main Assignment Number" Exxxxx, please see your payslip to find this information.
Position
Department where work was carried out?
e.g. After school / Breakfast club, Cover for Year 3 etc
Please explain the reason of this overtime?
e.g. Booster for Year 6B, to cover a staff member (mention staff name) in After school wrap around care etc
Overtime Details
Please select (add more rows by pressing the + button)
Total Hours
I have carried out the work detailed on this form and certify I am entitled to payment
Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
OFFICE USE ONLY
- Name
  
  First NameLast Name
- Signature
- STATUS
- Cost Code
- Should be Empty:

Overtime Details