Carlson Building Maintenance
   
   
Time Adjustment Form  ${month}/${day}/${year}
   
Time Adjustment Form Details
     
Employee Number: ${employeeNum} Employee Name: ${employeeName}
 
 
Adjustment for missed breaks:
${breakInfo}
Date: Start Time: End Time: Total Hours: Break Time: Adjusted Hours:
 
 
Reason this pay was missed:
${noteAdjustment}
 
 
**Signature/Approval - Please make sure to sign and print your name before turning in this form.
 
Employee: ${employeeName}
${employeeSig}
 ${month}/${day}/${year}
Manager: ${dm.userFirst} ${dm.userLast}
${dmSig}
 ${month}/${day}/${year}
  Print Sign Date
*Please Return this Completed form to the Payroll Department