Payroll Correction Form

Payroll Correction Form

Please input all information here. There is no need to contact us as this form serves as the notification. We will look into the issue and contact you if we need further clarification.
Name*

First NameLast Name
Payroll Period Start Date*

MonthDayYear
Listed as Reporting Period on Paystub
Payroll Period End Date*

MonthDayYear
Listed as Reporting Period on Paystub
Did Not Get Paid At All for ShiftReceived Incorrect Wage RateReceived Partial Payment for ShiftUploaded Manual Timesheet but Don't See PayOther
What is the correct wage rate amount? *
YesNo
Shift Date*

MonthDayYear
Date
Facility Name*
Clock In & Out Time *

Hour Minutes

AM/PM Option

Until
until
Hour Minutes

AM/PM Option
Total 0.0
LifeguardLifeguard ManagerLifeguard TrainingPool AttendantMaintenanceOther
Notes (If you need to add)
ADMIN STATUS
Date

MonthDayYear
Date
Trello Card Name (Name + Current Date + Facility)
Should be Empty: