Time Adjustment Request Form

Requested date *

Employee Name ( Last name, First name ) *

First

Last

Email *

Job Title *

Work location *

Reason for adjustment time *

Date to be corrected [Work date] *

If you need to correct the time for multiple dates, please provide the dates and times that need correction in the "Detailed reason" section below.

End date of the most recent pay period

Please check the 'Additional Statement Information' section of the most recent Payroll you received

Clock-in time *

Clock-out time *

Start time of lunch break

End time of lunch break

Total lunch break time (minutes)

Reason for not having a lunch *

Reason for correction *

Please provide detail of you work until the fingerprint is registered *

For example) 1. BBY - Tue, Sep 12th / 9am - 5pm ( Lunch 30mins )