PAYROLL DEDUCTION AUTHORIZATION FORM Sample Clauses

PAYROLL DEDUCTION AUTHORIZATION FORM. By (Please Print) Last Name First Name Middle Name To: Name of Employer Department Effective , 20 , I hereby request and authorize you to deduct from my earnings each payroll period an amount sufficient to provide for the regular payment of the current rate of monthly: (check one) 1) union dues; or 2) service fees as established by the Police Officers Association of Michigan. The amount deducted shall be paid to the Treasurer of the Police Officers Association of Michigan. Employee's Signature Street Address City and State
Sample 1Sample 2Sample 3See All (12)
AutoNDA by SimpleDocs
PAYROLL DEDUCTION AUTHORIZATION FORM. The Company or its contractor or subcontractor shall prepare for each worker’s signature a payroll deduction authorization form identifying all payroll deductions excluding those required by law, such as federal income taxes, Medicare and Social Security.
Sample 1Sample 2Sample 3
PAYROLL DEDUCTION AUTHORIZATION FORM. You are hereby authorized, until otherwise requested by me in writing, to deduct from wages earned by me while in your employ, the regular monthly dues and initiation fee for the International Union of United Automobile, Aerospace and Agricultural Implement Workers of America, Local #2192. Such regular monthly dues shall be equal to two (2) hours of pay per month at the employee's current hourly rate of pay. The aforesaid membership dues shall be remitted by you to the Financial Secretary of Local #2192 or his successor. Employee's Signature Date Witness (Unit Payroll Officer)
Sample 1Sample 2
PAYROLL DEDUCTION AUTHORIZATION FORM. CONTRACTOR, Subcontractor, and Sub subcontractor shall prepare for employee signature a payroll deduction authorization form to identify all payroll deductions excluding those required by statute, such as federal income taxes, Medicare and social security.
Sample 1Sample 2
PAYROLL DEDUCTION AUTHORIZATION FORM. As a payroll deductions xxxxxx, I hereby: 1) Authorize the Office of Parking Services to START CHANGE STOP my payroll deductions.
Sample 1Sample 2
PAYROLL DEDUCTION AUTHORIZATION FORM. I hereby authorize and direct the Nazareth Area School Board to deduct from my salary and transmit the amount of money deducted for my regular membership dues as certified or as may be certified to the Nazareth Area School Board by the Authorized officers of the Nazareth Area Education Association. This authorization to remain valid until the expiration of the present agreement between the Nazareth Area School Board and the Nazareth Area Education Association or any extension thereof unless a written revocation, giving fifteen (15) days notice, is submitted by me to the Nazareth Area School Board and the Nazareth Area Education Association. NAME ADDRESS SOCIAL SECURITY NO. BUILDING SIGNATURE DATE APPROVED BY NAZARETH AREA EDUCATION ASSOCIATION: BY OFFICE
Sample 1
PAYROLL DEDUCTION AUTHORIZATION FORM. As a payroll deductions xxxxxx, I hereby:
Sample 1
AutoNDA by SimpleDocs
PAYROLL DEDUCTION AUTHORIZATION FORM. During the life of this Agreement and in accordance with the terms of the form of authorization of check off of dues hereinafter set forth, the Committee agrees to deduct Union membership dues levied in accordance with the constitution of the Union from the pay of each employee who executes or has executed such form and remit the aggregate amount to the treasurer of the Union along with a list of the employees who had said dues th deducted. Such remittance shall be made by the tenth (10 ) day of the succeeding month.
Sample 1
PAYROLL DEDUCTION AUTHORIZATION FORM. Name: School: I hereby request and authorize the Board of Education of School District #54 to deduct from my earnings and transmit to the Association an amount sufficient to provide for regular payment of my obligation in conformance with Article III. Such amount will be annually certified by the Association. I understand that the deductions will be in eighteen (18) equal installments, starting with the fifth (5th) payroll period and continuing for the next seventeen (17) payroll periods. I also understand that if I should leave the District for any reason during the school term, the Board will deduct the full remainder of my unpaid obligation from my final paycheck. I hereby waive all right and claim for monies so deducted and transmitted in accordance with this authorization and relieve the Board and all its officers for any liability therefor. Date: Signature: District ID Number:
Sample 1

Related to PAYROLL DEDUCTION AUTHORIZATION FORM

  • Payroll Deductions An employee shall be entitled to have deductions from her salary assigned for the purchase of Canada Savings Bonds.

  • Payroll Deduction A. Membership dues of OCEA members in this Representation Unit and insurance premiums for such OCEA sponsored insurance programs as may be approved by the Board of Supervisors shall be deducted by the County from the pay warrants of such members. The County shall promptly transmit the dues and insurance premiums so deducted to OCEA.

  • Open Enrollment Period Open Enrollment is a period of time each year when you and your eligible dependents, if family coverage is offered, may enroll for healthcare coverage or make changes to your existing healthcare coverage. The effective date will be on the first day of your employer’s plan year. Special Enrollment Period A Special Enrollment Period is a time outside the yearly Open Enrollment Period when you can sign up for health coverage. You and your eligible dependents may enroll for coverage through a Special Enrollment Period by providing required enrollment information within thirty (30) days of the following events: • you get married, the coverage effective is the first day of the month following your marriage. • you have a child born to the family, the coverage effective date is the date of birth. • you have a child placed for adoption with your family, the coverage effective date is the date of placement. Special note about enrolling your newborn child: You must notify your employer of the birth of a newborn child and pay the required premium within thirty -one (31) days of the date of birth. Otherwise, the newborn will not be covered beyond the thirty -one (31) day period. This plan does not cover services for a newborn child who remains hospitalized after thirty-one (31) days and has not been enrolled in this plan. If you are enrolled in an Individual Plan when your child is born, the coverage for thirty- one (31) days described above means your plan becomes a Family Plan for as long as your child is covered. Applicable Family Plan deductibles and maximum out-of-pocket expenses may apply. In addition, if you lose coverage from another plan, you may enroll or add your eligible dependents for coverage through a Special Enrollment Period by providing required enrollment information within thirty (30) days following the date you lost coverage. Coverage will begin on the first day of the month following the date your coverage under the other plan ended. In order to be eligible, the loss of coverage must be the result of: • legal separation or divorce; • death of the covered policy holder; • termination of employment or reduction in the number of hours of employment; • the covered policy holder becomes entitled to Medicare; • loss of dependent child status under the plan; • employer contributions to such coverage are being terminated; • COBRA benefits are exhausted; or • your employer is undergoing Chapter 11 proceedings. You are also eligible for a Special Enrollment Period if you and/or your eligible dependent lose eligibility for Medicaid or a Children’s Health Insurance Program (CHIP), or if you and/or your eligible dependent become eligible for premium assistance for Medicaid or a (CHIP). In order to enroll, you must provide required information within sixty (60) days following the change in eligibility. Coverage will begin on the first day of the month following our receipt of your application. In addition, you may be eligible for a Special Enrollment Period if you provide required information within thirty (30) days of one of the following events: • you or your dependent lose minimum essential coverage (unless that loss of coverage is due to non-payment of premium or your voluntary termination of coverage); • you adequately demonstrate to us that another health plan substantially violated a material provision of its contract with you; • you make a permanent move to Rhode Island: or • your enrollment or non-enrollment in a qualified health plan is unintentional, inadvertent, or erroneous and is the result of error, misrepresentation, or inaction by us or an agent of HSRI or the U.S. Department of Health and Human Services (HHS).

  • Authorization for Leave The Chief Superintendent or designee shall be authorized to grant leaves in accordance with the Adoptive Leave Section, with the exception that additional leave requested in accordance with Section 3.6 shall require approval of the Board.

Time is Money Join Law Insider Premium to draft better contracts faster.