LOCAL 2078 LONGSHOREMAN LONGSHOREWOMAN

Payroll Correction Form

PAYROLL CORRECTION REQUEST

International Longshoremen’s Association – Local 2078

4921 Broadway Ave, Tampa, FL  |  (813) 807-7006

How it works: Fill in the boxes below, then tap Print / Save as PDF. For your privacy, the form erases itself after it prints or saves. Sign it by hand, have your foreman or header sign if you can, and turn it in to the union office with a copy of your check stub. Need a paper copy to fill out by hand? Tap Print Blank Form.

Privacy: Nothing you type here is sent or saved on this website — it stays on your own device.
1. Employee Information
2. Employer & Pay Period
3. Shifts Needing Correction

Total hours missed: 0.00  |  Estimated amount owed: $0.00

4. Explanation
Employee Signature & Date
Foreman / Header Signature & Date (verifies hours)

FOR UNION OFFICE USE ONLY

Received by:Date received:
Sent to employer on:Employer contact:
Status: ☐ Approved   ☐ Denied   ☐ PendingPaid on check dated: