FINAL PAYCHECK WORKSHEET



FINAL PAYCHECK WORKSHEET

Name: _________________________________________ Date: ___________________

Current Address: ________________________________________________________

Social Security #: __________________________ Prepared by: __________________

Employee paid previously through (date): ___________________________________

Unpaid hours begin on (date): _____________________________________________

Final date of employment: __________________ Time: __________________am/pm

ٱ The separation is a voluntary termination – (employee initiated: resignation, retirement) – the final paycheck must be issued within 72 hours of the final date of employment or by ____________________.

ٱ The separation is an involuntary termination – (employer initiated: discharge or layoff with no date of rehire) – all wages and accrued vacation earned but unpaid are due and payable on the last day of work.

Time:

Dates: |  |  |  |  |  |  |  |  | |Hours Worked |Mon |Tue |Wed |Thur |Fri |Sat |Sun |Total | |Regular Hours |  |  |  |  |  |  |  |  | |Overtime Hours |  |  |  |  |  |  |  |  | |Total Hours Worked |  |  |  |  |  |  |  |  | |

Dates: |  |  |  |  |  |  |  |  | |Hours Worked |Mon |Tue |Wed |Thur |Fri |Sat |Sun |Total | |Regular Hours |  |  |  |  |  |  |  |  | |Overtime Hours |  |  |  |  |  |  |  |  | |Total Hours Worked |  |  |  |  |  |  |  |  | |

Dates: |  |  |  |  |  |  |  |  | |Hours Worked |Mon |Tue |Wed |Thur |Fri |Sat |Sun |Total | |Regular Hours |  |  |  |  |  |  |  |  | |Overtime Hours |  |  |  |  |  |  |  |  | |Total Hours Worked |  |  |  |  |  |  |  |  | |

Totals: ________________Regular Time

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