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Payroll Discrepancy Form
  • THIS FORM SHOULD ONLY BE FILLED OUT IF YOU HAVE ALREADY RECEIVED YOUR PAYCHECK. This form must be filled out within 2 weeks of the pay date. 1.) To ensure accurancy and proper communication, payroll discrepancies will only be accepted in writing through this form. 2.) All fields must be completely filled out. Any information omitted from this form will result in a delay researching your discrepancy. 3.) All discrepancies will be thoroughly investigated. Only GHPM employees are authorized to submit a payroll discrepancy form. Forms submitted by anyone other than the employee will be rejected and considered invalid.
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  • Required Information
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  • First Name*
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  • Last Name:*
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  • Home Phone*(xxx-xxx-xxxx)
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  • Cell Phone*(xxx-xxx-xxxx)
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  • Email*(must be filled out to send form)
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  • Discrepancy Information
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  • Type of Discrepancy?*
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  • Account Manager*full name
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  • Pay Period of Discrepancy?*
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  • Please list date, time and location (pool) of each shift worked during the pay period*
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  • *By submitting this form, you certify that you are the person named above and you agree to the administration fee (if applicable).
    I agree to the 30 minute administration fee if I fail to report my discrepancy within 2 weeks of the pay date.
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  • Security Validationcopy the characters
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