Employers Group | Experts in Making Human Resources



[pic]

Final Paycheck Acknowledgement

I, the undersigned recipient, have received my final paycheck from __(Company Name)__.

The total amount of the paycheck is: __($)__

Paycheck amount represents:

Wages __($)__

Accrued Vacation Pay __($)__

Bonus __($)__

Commission __($)__

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 (please print) Dept.

________________________________________ _____________________

Signature of Recipient Date

_______________________________________ _____________________

Signature of Person Issuing Final Paycheck Date

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download