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Payroll Discrepancy Form 
Detailed description of hours and location worked for missing Pay Week:
Day 1:
Day 2:
Day 3:
Day 4:
Day 5:
Day 6:
Day 7:
Annual one time exemption:
Upload Photo of Paystub
Please note: Submission of form does not guarantee hours will be paid. 

Thanks for submitting!

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