Payroll Adjustment Request

1
Company Name* This field is required.
Enter the full legal name of your company or organization.
2
Security Verification RequiredPlease provide your email address to authorize this change.
example@example.com
3
Does this adjustment affect more than one employee?* This field is required.
Yes
No
4
Employee Details
If yes, please provide details of other employees affected by this adjustment.
5
Employee Full Name
First Name
Last Name
6
Select Adjustment Type* This field is required.
Please Select
Please Select
One-time bonus
Salary correction
Commission adjustment
Overtime pay
Deduction correction
Retroactive pay
Tax adjustment
Benefit adjustment
Time clock adjustment
PTO adjustment
Vacation adjustment
Choose the appropriate adjustment type from the list.
7
Which scheduled pay date should we apply this adjustment to?* This field is required.
Date
Month
Day
Year
8
Detailed Adjustment Explanation* This field is required.
Provide a detailed explanation of the adjustment, including reasons and any relevant information.
9
Feel free to upload any supporting documents or correspondence if you'd like to provide additional context for this request.
Drag and drop files here
Select files to upload
Max. file size: 10.0MB
Cancelof
10
Additional comments for payroll/HR
Add any additional comments or notes for payroll or HR consideration.
11
Internal Request ID
This internal ID is for tracking purposes only and will not be visible to employees.
Should be Empty: