Time Clock Adjustment Request
Submit a request to correct your time clock entry due to a missed or incorrect punch.
Employee Full Name
*
First Name
Last Name
Employee ID Number
*
Department
*
Please Select
Human Resources
Finance
Operations
Sales
IT
Marketing
Other
Contact Email
*
example@example.com
Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Time Clock Adjustment
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Type of Adjustment Needed
*
Clock-In
Clock-Out
Both
Original Clock Time(s) (if known)
Requested Correct Time(s)
*
Reason for Adjustment Request
*
Manager/Supervisor Name
*
Manager/Supervisor Email
*
example@example.com
Employee Signature
*
Submit Request
Submit Request
Should be Empty: