Time Clock Correction Request
Employees: If you failed to clock in/out or your time needs a correction, please complete this form before the payroll period ends. Use a separate form for each date. Enter the ACTUAL time you arrived or left, NOT your scheduled time.
Time Clock Information
Name
*
First Name
Last Name
Email
example@example.com
Date of Shift
*
-
Month
-
Day
Year
Date
Clock In Time
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
01
02
03
04
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47
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49
50
51
52
53
54
55
56
57
58
59
Minutes
AM
PM
AM/PM Option
Clock Out Time
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
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46
47
48
49
50
51
52
53
54
55
56
57
58
59
Minutes
AM
PM
AM/PM Option
Lunch Clock Out Time
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
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17
18
19
20
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39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
Minutes
AM
PM
AM/PM Option
Lunch Clock In Time
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
Minutes
AM
PM
AM/PM Option
Other Correction Needed
Explain other correction needed if any that cannot be addressed above
Reason for Correction
*
Supervisor Email
*
example@example.com
Employee Approval: I certify that the information reported above reflects the accurate correction needed for Payroll. I understand that if this correction caused an over payment to me I will be required to pay the money back to the company. I also understand if I am due money and this correction was not submitted in time for payment in current payroll the funds will be paid to me in the next payroll cycle.
Signature
*
Submit Form
Should be Empty: