Employment Interview Checklist - Silvers HR



Final Paycheck Acknowledgment

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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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