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Timekeeping Correction Form
1.) This form should be submitted within 48 hours of occurrence 2.) Please fill out the following information.
Do not leave any spaces blank.
3.) A 15 minute administration fee may be assessed. Only GHPM employees are authorized to submit a correction form. Forms submitted by anyone other than the employee will be rejected and considered invalid.
0
Required Information
1
Employee PIN #
*
2
First Name
*
3
Last Name:
*
4
Address:
*
5
City
*
6
State
*
Texas
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
7
Zip Code
*
8
Home Phone
*
(xxx-xxx-xxxx)
9
Cell Phone
*
(xxx-xxx-xxxx)
10
Email
*
(must be filled out to send form)
11
Name of pool where shift was worked:
*
12
Date shift was worked
*
MM/DD/YYYY
13
Times you worked:
*
(ex: 8-2p)
14
Winess Name
*
(First and Last) Witness must be the Manager on Duty (MOD) during the date and time listed above:
15
Reason For Time Adjustment
16
Reason for not clocking in/out: (Provide all details for your case)
*
17
I agree to the 15 minute administration fee. (Please note, if the clock in/out system is down/unavailable, you will not be charged the administration fee.) By clicking submit, you agree to the 15 minute administration fee.
*
I Agree
18
Security Validation
copy the characters
19
Submit Form
20
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