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Timekeeping Correction Form

Timekeeping Correction Form

  • This form should be submitted within 48 hours of occurrence
  • Please fill out the following information. Do not leave any spaces blank.
  • A 15 minute administration fee may be assessed.
Only GHPM employees are authorized to submit a correction form. Forms submitted by anyone other than the employee will be rejected and considered invalid.
Required Information
Employee PIN#:
First & Last Name (no nicknames):
Address:
City:
State:
Zip Code:
Home Phone:
Cell Phone:
Email Address:
Name of pool where shift was worked:
Date shift was worked (MM/DD/YYYY):
Times you worked:
Witness Name (First and Last) Witness must be the Manager on Duty (MOD) during the date and time listed above:
Reason for not clocking in/out:
I agree to the 15 minute administration fee. (Please note, if the clock in/out system is down/unavailable, you will not be charged the administration fee.) By clicking submit, you agree to the 15 minute administration fee.

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