Check-Off Authorization Form Sample Clauses

Check-Off Authorization Form. The parties agree that the check-off authorizations shall be in the following form: ASSIGNMENT AND AUTHORIZATION TO DEDUCT GUILD MEMBERSHIP DUES To: Foreign Policy I hereby assign to the Washington-Baltimore News Guild, Local 32035 The NewsGuild-CWA, and authorize Foreign Policy to deduct twice monthly from any salary earned or to be earned by me as an employee, an amount equal to Guild initiation fees and dues as certified by the Treasurer of the Guild starting in the first week in the month following the date of this assignment. I further authorize and request FP to remit the amount deducted to the Guild not later than the 30th day of each month. This assignment and authorization shall remain in effect until revoked by me, but shall be irrevocable for a period of one year from the date appearing below or until the termination of the contract between FP and the Guild, whichever occurs sooner. I further agree and direct that this assignment and authorization shall be continued automatically and shall be irrevocable for successive periods of one year each or for the period of each succeeding applicable contract between FP and the Guild, whichever period shall be shorter, unless written notice of its revocation is given by me to FP and to the Guild not more thirty (30) days and not less than fifteen (15) days prior to the expiration of each period of one year, or upon expiration of the contract between FP and the Guild, whichever occurs sooner. Such notice of revocation shall become effective for the calendar month following the calendar month in which FP receives it. This Assignment and authorization is voluntarily made in order to pay my equal share of the Guild’s costs of operation and is not conditioned on my present or future membership in the Guild. I agree to hold FP harmless against any and all claims and liability for or on account of the deductions made from my wages or other earnings and remitted to the Washington-Baltimore News Guild, TNG-CWA Local 32035. Print Name: Employee Signature: Date:
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Check-Off Authorization Form. (A) Bargaining unit members who wish to initiate deductions for membership dues and uniform assessments shall use the Dues Check-off Authorization Form (Appendix A). Immaterial changes to the form approved by FOP will not affect deductions authorized by a previous version of the form.
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Check-Off Authorization Form. I hereby request and authorize you to deduct from wages hereafter earned by me, while in the employ of the Xxxxxxxxxx County Sheriff, my Union dues of 1% of top base pay divided by twelve per month, or representation fee of 1% of top base pay divided by twelve per month. The amount deducted shall be paid to the Treasurer of the Union, according to the Agreement reached between the Employer and the Union. I recognize that by executing this authorization form, I will be bound to the Union security and check-off for the duration of this Agreement or the termination of my employment. PRINT: (Last Name) (First Name) (Middle Initial) Address City State (Social Security Number) DATE DEDUCTION IS TO START: / Month Year  (Signature of Employee) (Department) Date Signed:
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Check-Off Authorization Form. The Company shall not deduct any monies from an employee’s wages pursuant to Section 24 .1 of this Article, unless the checkoff authorization executed by the employee conforms exactly to the form set forth below . CHECK-OFF AUTHORIZATION
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Related to Check-Off Authorization Form

  • Proof of Authorization 5.3.1 Each Party shall be responsible for obtaining and maintaining Proof of Authorization (POA) as required by applicable federal and state law, as amended from time to time.

  • AGENT AUTHORIZATION FORM I/We, (Print Bidder name) , Do hereby authorize (print agent’s name), , to act as my/our agent to execute any petitions or other documents necessary to affect the CONTRACT approval PROCESS more specifically described as follows, (IFB NUMBER AND TITLE) , and to appear on my/our behalf before any administrative or legislative body in the county considering this CONTRACT and to act in all respects as our agent in matters pertaining TO THIS CONTRACT. Signature of Bidder Date STATE OF FLORIDA ) ) ss: COUNTY OF ) The foregoing instrument was acknowledged before me by means of ☐physical presence, or ☐online notarization, this day of , 20 , by [NAME OF PERSON], as [TYPE OF AUTHORITY,… e.g. officer, trustee, etc.)] for [NAME OF PARTY ON BEHALF OF WHOM INSTRUMENT WAS EXECUTED]. ☐Personally Known; OR ☐Produced Identification. Type of identification produced: . [CHECK APPLICABLE BOX TO SATISFY IDENTIFICATION REQUIREMENT OF FLA. STAT. §117.05] Notary Public My Commission Expires: (Printed, typed or stamped commissioned name of Notary Public) LEASED EMPLOYEE AFFIDAVIT I affirm that an employee leasing company provides my workers’ compensation coverage. I further understand that my contract with the employee leasing company limits my workers’ compensation coverage to enrolled worksite employees only. My leasing arrangement does not cover un-enrolled worksite employees, independent contractors, uninsured sub-contractors or casual labor exposure. I hereby certify that 100% of my workers are covered as worksite employees with the employee leasing company. I certify that I do not hire any casual or uninsured labor outside the employee leasing arrangement. I agree to notify the County in the event that I have any workers not covered by the employee leasing workers’ compensation policy. In the event that I have any workers not subject to the employee leasing arrangement, I agree to obtain a separate workers’ compensation policy to cover these workers. I further agree to provide the County with a certificate of insurance providing proof of workers’ compensation coverage prior to these workers entering any County jobsite. I further agree to notify the County if my employee leasing arrangement terminates with the employee leasing company and I understand that I am required to furnish proof of replacement workers’ compensation coverage prior to the termination of the employee leasing arrangement. I certify that I have workers’ compensation coverage for all of my workers through the employee leasing arrangement specified below: Name of Employee Leasing Company: Workers’ Compensation Carrier: A.M. Best Rating of Carrier: Inception Date of Leasing Arrangement: I further agree to notify the County in the event that I switch employee-leasing companies. I recognize that I have an obligation to supply an updated workers’ compensation certificate to the County that documents the change of carrier. Name of Contractor: Signature of Owner/Officer: Title: Date: INFORMATION FOR DETERMINING JOINT VENTURE ELIGIBILITY If the bidder is submitting as a joint venture, please be advised that this form MUST be completed and the REQUESTED written joint-venture agreement MUST be attached and submitted with this form. HOWEVER, IF THE BIDDER IS NOT A JOINT VENTURE, CHECK THE FOLLOWING BLOCK: ( ) NOT APPLICABLE

  • Authorization, Etc This Agreement and the Notes have been duly authorized by all necessary corporate action on the part of the Company, and this Agreement constitutes, and upon execution and delivery thereof each Note will constitute, a legal, valid and binding obligation of the Company enforceable against the Company in accordance with its terms, except as such enforceability may be limited by (i) applicable bankruptcy, insolvency, reorganization, moratorium or other similar laws affecting the enforcement of creditors’ rights generally and (ii) general principles of equity (regardless of whether such enforceability is considered in a proceeding in equity or at law).

  • Required Authorizations There is no requirement to make any filing with, give any notice to, or obtain any Authorization of, any Governmental Entity as a condition to the lawful completion of the transactions contemplated by this Agreement.

  • Prior Authorization A determination to authorize a Provider’s request, pursuant to services covered in the MississippiCAN Program, to provide a service or course of treatment of a specific duration and scope to a Member prior to the initiation or continuation of the service.

  • CERTIFICATE OF AUTHORITY The Trust and the Adviser shall furnish to each other from time to time certified copies of the resolutions of their Trustees or Board of Directors or executive committees, as the case may be, evidencing the authority of officers and employees who are authorized to act on behalf of the Trust, the Fund and/or the Adviser.

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