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*

“It is a great pleasure to work with Active. They provide exceptional service and their loyalty to POP Displays is huge. Last year, we hired 8 Active associates as permanent employees. These are skilled positions. All of them are still with us and doing a tremendous job. There are always going to be hiccups, but Active’s dedication, hard work and commitment is unmatched no matter what we ask. I’m looking forward to many years of working with Active Staffing.”

Ashley Bester, Human Resources Manager, POP Displays, Atlanta

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