Check Discrepancy Form

Please fill this form out if you have any discrepancies on your paycheck. If your check is missing, please fill out the Missing Check Form.

Check Discrepancy Form

First Name

Last Name

Home Phone

Cell Phone

Email

Employee Pin (Last 4 of Social Security Number)

Assigned Facility

Type of Discrepancy

Missing Hours

Hourly Rate

Pool Party Hours

Holiday Hours

Other

Who is your Manager/Supervisor?

Pay Period of Discrepancy?

Please list date, time and location (facility) of each shift worked during the pay period

I certify that the above information is true and correct to the best of my knowledge.

I agree

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