Time Clock Correction Form

Time Clock Correction Form
Employees: If you failed to clock in/out or your time needs a correction, please complete this form before the payroll period ends. Use a separate form for each date. Enter the ACTUAL time you arrived or left, NOT your scheduled time.
Time Clock Information
Name
First NameLast Name
Date of Shift
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Clock In Time
Hour Minutes
AM/PM Option
Clock Out Time
Hour Minutes
AM/PM Option
Break Clock Out Time
Hour Minutes
AM/PM Option
Break Clock In Time
Hour Minutes
AM/PM Option
Reason for Correction
Employee Approval: I certify that the information reported above reflects the accurate correction needed for Payroll.
Signature
Clear
Should be Empty: