Employee Check Correction Form

Date * +

Employee's Name *

Please check what was incorrect on your paycheck. *

Incorrect Rate

Incorrect Number of Hours

Deduction is Incorrect

What is dollar figure error according to your records? *

Please provide a detailed description on your paycheck error. *

I attest that the information I have submitted is correct and accurate. I understand that this will be forwarded to the Accounts Payable Department for review. I also understand that it takes 2 full business days to review my check correction, and I will be notified by the Accounts Payable Department or designee the results of my correction, and when and where ( if applicable ) I can pickup a check. *

Yes

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