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Payroll Discrepancy Submission Form
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Payroll Discrepancy Submission Form
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Date
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MM slash DD slash YYYY
Employee Name
*
First
Last
Employee Email
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Pay Period Start Date
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Pay Period End Date
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MM slash DD slash YYYY
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Copy of Check Stub:
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Reason for Payroll Discrepancies
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Pay Rate Incorrect
Paid Rate
Official Rate
Wrong Amount of Hours
Straight Time
Overtime
Wrong Deductions
Equipment
Training
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Note: Upon receipt of this form, our office will investigate your complaint. If do, a check will be issued within five business days. If you have any questions or concerns, please contact us during business hours.
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