Payroll Correction Form

Our payroll team wants to be sure you are paid for your hours worked and aims to correct any payroll problems promptly. Please complete the form below to report payroll issues and have them corrected.

Select Branch*
Name*
First Last
Applicant ID Number
Last 4 Digits of Social Security Number*
Company Name of Where You Worked
Department (Optional)
Date(s) Worked With Missing Hours
Date
Day of the Week
Start Time

: HH

MM
End Time

: HH

MM
Num. of Hours
Date
Day of the Week
Start Time

: HH

MM
End Time

: HH

MM
Num. of Hours
Date
Day of the Week
Start Time

: HH

MM
End Time

: HH

MM
Num. of Hours
Date
Day of the Week
Start Time

: HH

MM
End Time

: HH

MM
Num. of Hours
Date
Day of the Week
Start Time

: HH

MM
End Time

: HH

MM
Num. of Hours
Date
Day of the Week
Start Time

: HH

MM
End Time

: HH

MM
Num. of Hours
Date
Day of the Week
Start Time

: HH

MM
End Time

: HH

MM
Num. of Hours
Reason Why (Missing Hours or Did Not Receive Pay)*
Please Add Any Additional Info (Ex. Supervisor Name, Supervisor Phone Number):
E-mail Address*

“3V and Drink Smartfruit™ have been clients of Active Staffing for many years. We have always received reliable and trustworthy service from both their corporate office and the temp staff. We have employed Active Staffing temps in our facility on a regular basis (five days a week, full-time) and have been extremely satisfied with the level of professionalism and the ability to perform tasks as instructed.”

Carmen Doreste, Accounting Manager, 3V Company & Drink Smartfruit™

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