HistoricalEditRequestForm
EmployeeType:
EmployeeNSUID# EmployeeLastName,FirstName
Temp
Exempt
Non‐Exempt
Student
ActivityCode
Day
Select
MM/DD/YY
Ente
Day DATE IN OUT
IN OUT IN
OUT
Day
Select
MM/DD/YY
Enter
Day DATE TYPE HRS TYPE
HRS
Phone #
Date
Date
SubmitformviaemailtoyourPayrollRep
Reasonforchange:
OriginalPunches
Enter In/outpunches
Corrected Punches
EnterIn/outpunches
DepartmentName
AdjustmentforPunches
EmployeeonLeavewithMatrix?
Supervisor/ Coordinator Signature
EmployeeSignature
AdjustmentforTime‐Off(VAC,PER,SIC,BER,JUR,STD)
Reasonforchange:
Original or Docked Entry
SelectTypeofTimeOff&enterHRS
Corrected Entry
SelectTypeofTimeOff&enterHRS
Note:Changes,includingmonetaryorother,willbeincludedon
thenextpaycycleaftertheformissubmitted.Thedeadlinetosubmittheformtobeincludedinthenextcycle
willbebyThursday,3:00pmafterthepaydateeffected.
Payroll Only:
Historical Edit
Historical Edit Log
Entered by: _________
***************************************************************************************************************************
Historical Edit w/Pay
Banner Correction
Pay # ______
Pay Period Begin ______________
Pay Period End ______________
Request Reason:
Missed Approval
Missed Request
Docked Time
Approved STD
Section 1.
Section 2.
Section 3.
Section 4.
Section 5.
Print Name
Print Name
Phone #
IN
OUT
N
Job Name/#
Revised 09/20/2018
click to sign
signature
click to edit
click to sign
signature
click to edit