EMPLOYEE TIME CORRECTION FORM

Employee Time Correction Form

Payroll will be calculated based on hours submitted by employee via the telephony system. Caregivers will clock in at the beginning of their shift and clock out at the end of their shift. Failure to clock in or out will result in an incorrect paycheck which can only be corrected by submitting this form.

  • Date Format: MM slash DD slash YYYY
  • Missing Clock-In Time

  • Date Format: MM slash DD slash YYYY
  • :
  • Missing Clock-Out Time

  • Date Format: MM slash DD slash YYYY
  • :
  • Employee Certification*

    The times listed above are an accurate statement of actual time worked. All above adjustments must have an explanation to be paid and must be approved by a supervisor.