Payroll Adjustment Form

Payroll Adjustment Form

Important: This form is for payroll discrepancies from past payrolls that can no longer be corrected with a missed punch form via Paycom. Prior to completing and submitting this form, please ensure you have coordinated the issue with your manager and received their approval.
Employee Information
Employee Name*

First NameLast Name
Job Title*
Property/Location*
Email*
example@example.com
Managers Name*

First NameLast Name
Managers Email*
example@example.com
Missing HoursMissing Leasing CommissionsMissing Renewal CommissionsMissing Delinquency BonusMissing Holiday hoursOver Paid HoursBonus Pay outAuto Allowance AdditionAuto Allowance IncreaseAuto Allowance removalOther
If you selected other please give details:
Missing/overpaid Hours (if applicable): Please enter the dates and corresponding hours missing.
Total missing hours? add a zero if not missing hours *
Total overpaid hours? add a zero if not missing hours *
Amount of Bonus:
Amount of Auto Allowance
Timecard Screen shot

Cancelof
I acknowledge that submitting fraudulent payroll discrepancies is a serious violation of company policy and may result in disciplinary action, up to and including termination. I certify that the information I have provided is true and accurate to the best of my knowledge.
Signature*

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Date*

MonthDayYear
Date
Should be Empty:

Employee Information