Payroll Discrepancy
Employee Name
*
First Name
Last Name
Contact Phone Number
*
E-mail
*
Pay Period Ending Date
*
-
Month
-
Day
Year
Pay periods end every other Sunday. Those are the only options.
Employee Division
*
South (Westchester/Rockland)
North
Montefiore (Monte 911 only)
West (Sullivan)
Missing / Incorrect Shifts
*
Hours Worked Please Fill in the Hours Using Military Time Format
Date
Shift
Start
End
Reason
Sun
Mon
Tues
Wed
Thurs
Fri
Sat
Sun
Mon
Tues
Wed
Thurs
Fri
Sat
Comments
Submit
Should be Empty: