PAYROLL DISCREPANCY FORM

PLEASE FAX THE COMPLETED FORM TO THE

PAYROLL DEPT AT 604.294.1373

OFFICE USE ONLY

EMPLOYEE NAME:

BILLABLE:
PHONE #

EMPLOYEE NUMBER:

YES

NO

BILLABLE TO:

EMAIL ADDRESS:
DATE SUBMITTED:
(DAY)

(MONTH)

(YEAR)

(DAY)

(MONTH)

(YEAR)

EMPLOYEE
NOTIFIED:

CHEQUE DATE:

HOURS WORKED DURING PAY PERIOD:

WEEK 1:

DATE

START TIME

FINISH TIME

OFFICE USE
ONLY

SITE NAME

SUNDAY
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY

***ALL SHIFTS WORKED IN THE PAY PERIOD MUST BE LISTED***

WEEK 2:

DATE

START TIME

FINISH TIME

OFFICE USE
ONLY

SITE NAME

SUNDAY
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SATURDAY

PLEASE PROVIDE A DESCRIPTION OF THE DISCREPANCY:

**A COPY OF THE APPLICABLE PAY STUB MUST BE ATTACHED TO THIS FORM**
HOW DO YOU WISH THIS SHORTAGE TO BE PAID (MARK AN "X" IN THE APPROPRIATE BOX)
WITHIN THREE OFFICE DAYS:

NEXT PAYROLL:

NOTE: TO EXERCISE THE THREE DAY OPTION, THE DISCREPANCY MUST BE GREATER THAN 5 HOURS OF REGULAR PAY