Pay Discrepancy

1
Name* This field is required.
First Name
Last Name
2
Email
example@example.com
3
Phone Number
Area Code
Phone Number
4
Today's Date* This field is required.Enter today's date so we know when you filled this form out.
Date
Year
Month
Day
5
First Week Start Date* This field is required.Enter the date of the first Sunday in the pay period.
Date
Year
Month
Day
6
Second Week Start Date* This field is required.Enter the date of the second Sunday in the pay period.
Date
Year
Month
Day
7
Hours Worked* This field is required.Please fill in all of the hours that you worked during the entire 2 week pay period. We will then compare them to our internal records and time sheets to see where the issue may be.
Venue/Location
Date
Total Hours
Sign In? Y/N
Supervisor
W1 - Sun
W1 - Mon
W1 - Tue
W1 - Wed
W1 - Thu
W1 - Fri
W1 - Sat
W2 - Sun
W2 - Mon
W2 - Tue
W2 - Wed
W2 - Thu
W2 - Fri
W2 - Sat
W1 - Sun
W1 - Mon
W1 - Tue
W1 - Wed
W1 - Thu
W1 - Fri
W1 - Sat
W2 - Sun
W2 - Mon
W2 - Tue
W2 - Wed
W2 - Thu
W2 - Fri
W2 - Sat
Venue/Location
Date
Total Hours
Sign In? Y/N
Supervisor
Venue/Location
Date
Total Hours
Sign In? Y/N
Supervisor
Venue/Location
Date
Total Hours
Sign In? Y/N
Supervisor
Venue/Location
Date
Total Hours
Sign In? Y/N
Supervisor
Venue/Location
Date
Total Hours
Sign In? Y/N
Supervisor
Venue/Location
Date
Total Hours
Sign In? Y/N
Supervisor
Venue/Location
Date
Total Hours
Sign In? Y/N
Supervisor
Venue/Location
Date
Total Hours
Sign In? Y/N
Supervisor
Venue/Location
Date
Total Hours
Sign In? Y/N
Supervisor
Venue/Location
Date
Total Hours
Sign In? Y/N
Supervisor
Venue/Location
Date
Total Hours
Sign In? Y/N
Supervisor
Venue/Location
Date
Total Hours
Sign In? Y/N
Supervisor
Venue/Location
Date
Total Hours
Sign In? Y/N
Supervisor
Venue/Location
Date
Total Hours
Sign In? Y/N
Supervisor
1 of 14
8
Number of Missing Hours* This field is required.Enter the total number of hours that you are missing from your check.
9
Number of Hours Paid For* This field is required.Enter the total number of hours that you have been paid for.
10
Total Amount Paid* This field is required.Enter your check total dollar value for this pay period.
11
Additional Information
Huge
Large
Normal
Small
Ok
Ok
12
Employee Signature* This field is required.
Clear
Should be Empty:

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