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Pay Discrepancy
If there was an error on your pay check please fill out the following form in order for us to investigate the issue and you will be contacted within 48 hours.
11
Questions
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1
Name
*
This field is required.
First Name
Last Name
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2
Email
example@example.com
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3
Phone Number
Area Code
Phone Number
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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
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5
Week Start Date
*
This field is required.
Enter the date of the first Sunday in the pay period.
-
Date
Year
Month
Day
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6
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
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
Row 0, Column 4
W1 - Mon
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
Row 1, Column 4
W1 - Tue
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Row 2, Column 4
W1 - Wed
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Row 3, Column 4
W1 - Thu
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Row 4, Column 4
W1 - Fri
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
Row 5, Column 3
Row 5, Column 4
W1 - Sat
Row 6, Column 0
Row 6, Column 1
Row 6, Column 2
Row 6, Column 3
Row 6, Column 4
W1 - Sun
W1 - Mon
W1 - Tue
W1 - Wed
W1 - Thu
W1 - Fri
W1 - Sat
Venue/Location
Row 0, Column 0
Date
Row 0, Column 1
Total Hours
Row 0, Column 2
Sign In? Y/N
Row 0, Column 3
Supervisor
Row 0, Column 4
Venue/Location
Row 1, Column 0
Date
Row 1, Column 1
Total Hours
Row 1, Column 2
Sign In? Y/N
Row 1, Column 3
Supervisor
Row 1, Column 4
Venue/Location
Row 2, Column 0
Date
Row 2, Column 1
Total Hours
Row 2, Column 2
Sign In? Y/N
Row 2, Column 3
Supervisor
Row 2, Column 4
Venue/Location
Row 3, Column 0
Date
Row 3, Column 1
Total Hours
Row 3, Column 2
Sign In? Y/N
Row 3, Column 3
Supervisor
Row 3, Column 4
Venue/Location
Row 4, Column 0
Date
Row 4, Column 1
Total Hours
Row 4, Column 2
Sign In? Y/N
Row 4, Column 3
Supervisor
Row 4, Column 4
Venue/Location
Row 5, Column 0
Date
Row 5, Column 1
Total Hours
Row 5, Column 2
Sign In? Y/N
Row 5, Column 3
Supervisor
Row 5, Column 4
Venue/Location
Row 6, Column 0
Date
Row 6, Column 1
Total Hours
Row 6, Column 2
Sign In? Y/N
Row 6, Column 3
Supervisor
Row 6, Column 4
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7
Number of Missing Hours
*
This field is required.
Enter the total number of hours that you are missing from your check.
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8
Number of Hours Paid For
*
This field is required.
Enter the total number of hours that you have been paid for.
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9
Total Amount Paid
*
This field is required.
Enter your check total dollar value for this pay period.
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10
Additional Information
Huge
Large
Normal
Small
Ok
quote
Created with Sketch.
Ok
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11
Employee Signature
*
This field is required.
Clear
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