PAYROLL ADJUSTMENT FORM

Amkor Technology Philippines, Inc.

CONTROL #
Revised effective April 23, 2010
INSTRUCTIONS:
1. Fill out the form completely and attach the necessary documents/obtain the required signatures.
2. Submit within 48 hrs. from date of incident. Sign on the logbook and indicate your CONTROL # (upper right column)
REASON FOR ADJUSTMENT
[ ] Exceeded max. OT hrs. allowed (with President/site GM's approval)
[ ] OB (attach approved OB/Amsaf form and proof of attendance)
[ ] Request for change shift, RD, linecode and logbox
[ ] Losts or Forgot ID (attach TAB)
[ ] Others, pls. describe
CHANGES
EMP NO

EMP NAME

REST DAY
From

SHIFT
To

From

LINECODE
To

From

LOGBOX

To

From

EFFECTIVITY

To

DATE

FOR AMS ADJUSTMENT

EMP NO

APPROVALS:

EMP NAME

PRINT NAME

LINECODE

Date Of
Incident

OT HOURS
>8 hrs reg

Date

Signature

OB

>16 hrs

In

Lost/Forgot ID
Out

E-mail

In

Out

Local

Incomplete Swipes
In

Out

Linecode

Supervisor
Dept. Mgr.
Security
GM
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

PAYROLL ADJUSTMENT FORM

Amkor Technology Philippines, Inc.
CONTROL #
Revised effective April 23, 2010
INSTRUCTIONS:
1. Fill out the form completely and attach the necessary documents/obtain the required signatures.
2. Submit within 48 hrs. from date of incident. Sign on the logbook and indicate your CONTROL # (upper right column)
REASON FOR ADJUSTMENT
[ ] Exceeded max. OT hrs. allowed (with President/site GM's approval)
[ ] OB (attach approved OB/Amsaf form and proof of attendance)
[ ] Request for change shift, RD, linecode and logbox
[ ] Losts or Forgot ID (attach TAB)
[ ] Others, pls. describe
CHANGES
EMP NO

EMP NAME

REST DAY
From

LINECODE

SHIFT
To

From

To

From

LOGBOX

To

From

EFFECTIVITY

To

DATE

FOR AMS ADJUSTMENT

EMP NO

APPROVALS:
Supervisor
Dept. Mgr.
Security
GM

EMP NAME

PRINT NAME

LINECODE

Date Of
Incident

Signature

OT HOURS
>8 hrs reg

Date

OB

>16 hrs

E-mail

In

Lost/Forgot ID
Out

In

Local

Out

Incomplete Swipes
In

Linecode

Out