[PDF]Payroll Discrepancy Form - Rackcdn.com365f40c553260482ac48-22cc9316ebe17550a0cfc7a1de2fafa9.r29.cf2.rackcdn.com/...
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Payroll Discrepancy Form Your Name:
Employee ID:
Today's Date:
Reason for Discrepancy:
Date of check:
Customer
Date
Hours Worked
Project Rate
Wage Total
Total Miles Driven
Travel Pay
Total Pay (Wage + Travel)
example
Project
City
example
State
Store #
What you were paid
example
example
5/7
10
$10.00
$100.00
50
$18.75
$81.25
This should be the amount of the total discrepancy.
Totals: Customer
Date
Hours Worked
Project Rate
Wage Total
Total Miles Driven
Travel Pay
Total Pay (Wage + Travel)
Difference from paid amount
example
Project
City
example
State
Store #
What you should have been paid
example
example
5/7
10
$12.00
$120.00
50
$18.75
$101.25
$20.00
Totals: In order for the discrepancy to be processed, you must include the Weekly Timesheets that are in dispute. If the timesheets are not included, this discrepancy will not be processed. Please contact the Scheduler for the mis-paid job for instructions on submitting this form
Your signature:
Date:
Management Approval:
Date:
