Turning Point Family CARE, PLLC
Employee Check Correction Form
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Date
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Employee Name:
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Please check what was incorrect on your paycheck?
Incorrect Rate
Incorrect Number of Hours
Non-billable Time Incorrect
Training Not Included
Supervision Not Included
CFT Not Included
Deduction is Incorrect
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What is dollar figure error according to your records?
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Please provide a detailed description on your paycheck error:
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I attest that the information that I have submitted is correct and accurate. I understand that this will be forwarded to Mr. Stanford for review. I also understand that it takes
1 full business day
to review my check correction, and I will be notified by Mr. Stanford or his designee to the results of my correction, and when and where (if applicable) that I can pickup a check.
YES
NO
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Indicates Response Required