TIME CLOCK AUTHORIZATION and/or ADJUSTMENT

EMPLOYEE NAME:
EMPLOYEE NUMBER:
DEPARTMENT:
SUPERVISOR:

Date and Time Adjustment is Necessary:
Please submit one form per date. Must be completed and signed and authorized within 24 hours of error OR
adjustment may not appear until the following pay period. Habitual users are subject to discipline.

DATE	START TIME	END TIME

Reason for Adjustment:
 

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