Payroll Inquiry Form
Employee Name
*
First Name
Last Name
Date form completed
*
-
Month
-
Day
Year
Date
Employee Return Phone Number
-
Area Code
Phone Number
Employee Return Email
*
example@example.com
Work location:
ICF-Park West
SCL
Open Door Art Studio
CAC, Career Services, Transportation
UCO
Corporate
Other
Payroll Date:
-
Month
-
Day
Year
Date of paycheck issue
Category of Payroll Issue:
Paycheck incorrect
Mileage or other expense reimbursement
Paid time off issue (Vacation, sick time)
List in as much detail as possible what the pay issue is, including all of the information necessary to correct the issue: (including shift time and date, location, etc..):
(NOTE: All Open Door staff are required to properly document time per policy. Until time is verified, payroll cannot be issued. IF staff fail to complete time record, it may result in delay in pay.)
Please upload any picture of pay stub, document, or other supporting evidence to support the pay issue as listed above (If applicable):
Browse Files
Upload File here (if applicable)
Cancel
of
FOR OPEN DOOR ACCOUNTING PERSONNEL RESPONSE ONLY:
Accounting personnel name
First Name
Last Name
Nature of issue/ underlying cause:
Immediate action taken to resolve issue:
Date follow-up completed:
-
Month
-
Day
Year
Date
Message to Employee:
Submit
Should be Empty: