/  Time Adjustment Request Form

Time Adjustment Request Form

Please submit this form to request your non-paid break time adjustment.

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.
Please check the 'Additional Statement Information' section of the most recent Payroll you received
This form will be sent to the Dr.Lee and managers, James and Mark, for the time adjustment.