Copy sent to Payroll:

________________
(Date)

Missed Punch

 Anaheim  Orange  Freedom  BDO  Main

Employee Name: Today’s Date:

Department: Supervisor/Manager Name:

Reason for missed punch: ___________________________ Meal Penalty

Below is the date and time of my missed punch. Please adjust my timecard as indicated:

Mon Tue Wed Thu Fri Sat Sun

Date:

Missing
IN Time:

Missing
OUT for
Lunch
Time:
Missing
IN from
Lunch
Time:
Missing
END OF
SHIFT
Time:

By signing below, I confirm that the information listed on this form is accurate. I have taken all meal and rest periods
afforded to me as mandated by company policy, State or Federal Law.

Employee Signature:

Manager/Supervisor Signature:

FOR OFFICE USE ONLY:

Date Received By: Date:

Entered into Time & Attendance By: Date:

MeriCal LLC. MeriCal LLC. MeriCal LLC.

231 E. Bristol Lane 2995 E. Miraloma Avenue 3804 S. Airport Road
Orange, CA 92865 Anaheim, CA 92806 Ogden, UT. 84405