Payroll Discrepancy Form

Driver Name*
Driver Email*
Driver Phone*
Client*
Work Week Dates
Work weeks are Monday - Sunday
Pay Date
Date Format: MM slash DD slash YYYY

Pay dates are Friday
Did You Use The F|Staff App?
- Yes
- No
Did You Take A lunch?
- Yes
- No
Regular Hours Missing
Overtime Hours Missing
Other Hours Missing
Additional Information
How Should This Correction Be Made?
- Please adjust my check to reflect this correction for the next pay date
- Please issue a check reflecting this correction
Signature*