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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.
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  • Required Information
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  • Employee PIN #*
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  • First Name*
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  • Last Name:*
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  • Address:*
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  • City*
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  • State*
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  • Zip Code*
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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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  • Name of pool where shift was worked:*
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  • Date shift was worked*MM/DD/YYYY
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  • Times you worked:*(ex: 8-2p)
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  • Winess Name*(First and Last) Witness must be the Manager on Duty (MOD) during the date and time listed above:
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  • Reason For Time Adjustment
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  • Reason for not clocking in/out: (Provide all details for your case)*
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  • 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
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  • Security Validationcopy the characters
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