EVV Correction Form

EVV Correction Form
Employee Name/Nombre del Empleado:*

First NameLast Name
Person Served Name/Nombre del Cliente:*

First NameLast Name
Service/Servicio*
Email/Correo Electrónico:*
example@example.com
Date of Error/Fecha de Error:*

MonthDayYear
Date
Choose a time*

Hour Minutes

AM/PM Option
Choose a time 2*

Hour Minutes

AM/PM Option
Reason for Error/Razon de Error:*
I have more hours to Submit/Tengo más horas para enviar

YesNo
copy of Date of Error/Fecha de Error:

MonthDayYear
Date
copy of Time In

Hour Minutes

AM/PM Option
copy of Time Out

Hour Minutes

AM/PM Option
Reason for Error/Razon de Error:
I acknowledge by signing below, I understand I am required to clock in and out of my shift using the EVV system. I understand and agree that all misse*

Acept
Signature*

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Should be Empty: