Phone: (415) 441-6400
Payroll Resolution Form

First Name:

Last Name:

Email Address:

Cell Phone:

Todays Date:
Job #:
Job Start Date:
Job End Date:
Employer:
Payroll Company:
Site:
Steward:

Reason for Payroll

Resolution

Total Hours Worked Date:
Reg:
OT:
DT:
Show:
Meal Penalty:
Total Paid:
Total Owed:
Mailing Address:
Start Paperwork Filled Out?
Did you change addresses in the last month?
Notes:

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Contact Info
I.A.T.S.E. Local 16
240 Second Street
San Francisco, CA 94105
  (415) 441-6400

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