Employment Interview Checklist
Final Paycheck Acknowledgment
| |
I, the undersigned recipient, have received my final paycheck from: _________________________
Company Name
The total amount of the net paycheck is: $ __________
Paycheck amount represents:
Wages $ __________
Accrued Vacation or PTO Pay $ __________
Other _________________________ $ __________
_________________________ $ __________
_________________________ $ __________
_________________________ $ __________
_________________________ $ __________
Deductions
_________________________ $ __________
_________________________ $ __________
_________________________ $ __________
_________________________ $ __________
_________________________ $ __________
_________________________ $ __________
_________________________ $ __________
To the best of my knowledge, there is no additional money owed to me by the employer at the present time.
_____________________________
Name of Recipient
_____________________________
Street Address of Resident
_____________________________
City, State and Zip Code
________________________________________________________ __________
Signature of Recipient Date
________________________________________________________ __________
Signature of Person Issuing Final Paycheck Date
................
................
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