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403.27-E - Pay Deduction Complaint Form

Click here to download the Pay Deduction Complaint Form

This form is to be used for all pay deduction complaints. Any employee who believes the district has made an inappropriate deduction is encouraged to immediately consult with their direct supervisor. The employee may also file this complaint form with the Chief Officer of Human Resources explaining the nature of the improper deduction. 

Name of employee: ______________________________________________

Department/Building: _____________________________________________

Payroll date(s): __________________________________________________

Amount of improper pay deduction: __________________________________

Explanation of improper pay deduction: ______________________________________________________________________


Supervisor Signature: __________________________________ Date: _______________________________

Employee Signature: __________________________________ Date: ________________________________

Return the signed form to:
Linn-Mar Community School District
Human Resources Office
2999 N 10th Street
Marion IA 52302

Reviewed: 9/14; 8/17; 6/20; 4/23
Related Policy: 403.27; 403.27-R
Legal Reference (Code of Iowa): §§ 91A.2(4), .3; 294.8-9, .16; 29 USC Sec 2 13(a); 29 CFR Pt 541
IASB Reference: 706.02-03; 706.03-R(1)