Common use of Payroll Deduction Authorization Clause in Contracts

Payroll Deduction Authorization. NAME JOB TITLE The undersigned hereby authorizes Sisters of Charity Hospital to deduct from my wages: CHECK EITHER: MEMBER The monthly dues and one initiation fee as certified to the Employer from time to time by the Secretary-treasurer of the Communications Workers of America, and remit same to the Secretary-treasurer of the Communications Workers of America as his/her duly authorized agent. This authorization may be revoked by me at any time by written request to the Employer and by sending a copy of such request to the Secretary-treasurer of the Union, or AGENCY FEE PAYER A service charge equal to the monthly dues as certified to the Employer from time to time by the Secretary-treasurer of the Communications Workers of America as his/her duly authorized agent. This authorization may be revoked by me at any time by written request to the Employer and by sending a copy of such request to the Secretary-treasurer of the Union. Union membership dues and agency fees are not deductible as charitable contributions for Federal income tax purposes. Dues and agency fees, however, may be deductible in limited circumstances subject to various restrictions imposed by the Internal Revenue Code. Resident Address Signature of Employee City/Town State Zip Code Social Security Number Date of Birth Date Received by Company Date Effective During the negotiations that resulted in this Agreement, the parties agreed to delete the job titles of staff development/patient educator and case manager from the inclusion language outlined in Article 3, Section 1., and to include those same job titles under the exclusion language in Article 3, Section 1. The intent of this change is to ensure that the inclusion language accurately reflects the current composition of the bargaining unit. It was further agreed by the parties, that if St. ▇▇▇▇▇▇ Campus were to re-employ nurse educators or case managers, the job titles and the employees hired to work in those job titles would return to the bargaining unit.

Payroll Deduction Authorization. NAME JOB TITLE The undersigned Hire Date Current Date For The: University of Michigan By: (Last Name) (First Name) (Middle) Effective: , 20 . (Starts the first payroll of the month) I hereby authorizes Sisters of Charity Hospital request and authorize you to deduct from my wagesearnings once each month, an amount established by the Union as monthly dues. The amount deducted shall be paid to: CHECK EITHERSignature: MEMBER The monthly dues and one Mailing Address: Number Street City Zip Pick One - Union Dues or Service Fee (Initials) (Initials) 15-1 University of Michigan, Command Officer’s Association Any new employee may pay the initiation fee as certified of Twenty Dollars ($20.00). Any member of U-M, COA who returns to the Employer from time Association after leaving the Association shall not have to time by pay the Secretary-treasurer of the Communications Workers of Americainitiation fee, and remit same if said employee returns to the SecretaryAssociation within three years (3) of leaving this Association, known as U-treasurer of the Communications Workers of America as his/her duly authorized agentM COA. Signature: ▇▇▇▇▇▇▇: EMAIL Address: This authorization may form shall be revoked hand delivered to University Human Resources @ Wolverine Tower by me at any time by written request to the Employer and by sending a copy of such request to the Secretary-treasurer of the Union, or AGENCY FEE PAYER A service charge equal to the monthly dues as certified to the Employer from time to time by the Secretary-treasurer of the Communications Workers of America as his/her duly authorized agent. This authorization may be revoked by me at any time by written request to the Employer and by sending a copy of such request to the Secretary-treasurer of the Union. Union membership dues and agency fees are not deductible as charitable contributions for Federal income tax purposes. Dues and agency fees, however, may be deductible in limited circumstances subject to various restrictions imposed by the Internal Revenue Code. Resident Address Signature of Employee City/Town State Zip Code Social Security Number Date of Birth Date Received by Company Date Effective During the negotiations that resulted in this Agreement, the parties agreed to delete the job titles of staff development/patient educator and case manager from the inclusion language outlined in Article 3, Section 1., and to include those same job titles under the exclusion language in Article 3, Section 1. The intent of this change is to ensure that the inclusion language accurately reflects the current composition of the bargaining unit. It was further agreed by the parties, that if St. ▇▇▇▇▇▇▇ Campus were to reof COAM where a copy of this document will be stamped by an authorized person and retained by COAM. Rev: 04/15 15-employ nurse educators 2 Payroll deductions shall be made only from the pay due employees on the last pay day of each calendar month. The initial deduction for any employee, however, shall not begin unless both (1) a properly executed “Voluntary Authorization for Deduction of Union Dues or case managers, Service Charge”; and (2) the job titles and amount of the employees hired to work in those job titles would return monthly membership dues or service charge certified by the Financial Secretary of the Union has been delivered to the bargaining unitUniversity at a place designated by the University at least thirty (30) calendar days prior to the last pay day of the calendar month. Changes in the amount of the monthly membership dues or service charge also must be delivered to the University at a place designated by the University, at least thirty (30) calendar days prior to the last pay day of the calendar month before the change will become effective.

Payroll Deduction Authorization. NAME JOB TITLE The undersigned Date________________________ I, the undersigned, a member of _________________, hereby authorizes Sisters of Charity Hospital request and voluntarily authorize the Employer to deduct from my wages: CHECK EITHER: MEMBER The any wages or compensation due me, an amount equal to the regular monthly dues uniformly applicable to members of ___________________ ("Union") in accordance with the Constitution and one initiation fee Bylaws of the Union. This authorization shall remain in effect and shall be irrevocable unless I revoke it by sending a written notice to both the Employer and __________, by registered mail during a period of fifteen (15) days immediately succeeding any yearly period subsequent to the date of this authorization or subsequent to the date of termination of the applicable contract between the Employer and the Union, whichever occurs sooner, and shall be automatically renewed as certified an irrevocable Check-Off from year to year unless revoked as herein above provided. 3. Deductions shall be made only in accordance with the provisions of said Authorization for Check-Off of Dues, together with the provisions of this Check-Off Agreement. 4. The original or a facsimile of a properly executed Authorization of Check-Off of Dues form for each employee for whom Union membership dues are to be deducted hereunder shall be delivered to the Employer from time before any payroll deductions are made. Deductions shall be made thereafter only under Authorization for Check-Off of Dues forms which have been properly executed and are in effect. Any Authorization for Check-Off of Dues which is incomplete or in error will be returned to time the Union by the SecretaryEmployer. 5. Check-treasurer off deductions under all properly executed Authorization for Check-Off of Dues forms which have been delivered to the Employee on or before the fifteenth (15th) day of any particular month thereafter shall begin with the following calendar month. 6. Deductions shall be made in accordance with the provisions of this Check-Off of Union Membership Dues section, from the pay received on the first payday of each month regardless of the Communications Workers payroll period ending date represented on that payroll check. These provisions for dues deductions shall not apply to banquet workers. 7. The Employer agrees to make deductions as otherwise provided in this Check-Off of America, and remit same Union Membership Dues section in the case of employees who have returned to work after authorized leave of absence. 8. In cases where a deduction is made which duplicates a payment already made to the Secretary-treasurer Union by an employee, or where a deduction is not in conformity with the provisions of the Communications Workers of America as his/her duly authorized agent. This authorization may be revoked by me at any time by written request Union Constitution and By-laws, refunds to the employee will be made by the Union. 9. The Employer and by sending a copy of such request shall remit each month to the Secretary-treasurer designated financial officer of the Union, the amount of deductions made for that particular month, together with a list of employees 12 13 and their Social Security numbers, for whom such deductions have been made. The information shall be in computer readable electronic form, in any one of the following media: 1. 8mm cartridge; 2. 1/2 nine track tape, 1600 or AGENCY FEE PAYER A service charge equal 6250 BPI; 3. 8" diskette; 4. 5-1/4" or 3-1/2" diskette in ASCII format. The remittance shall be forwarded to the monthly dues as certified above designated financial officer not later than the fifteenth (15th) of the month, for the deduction from the first paycheck received by the employee (prior to the Employer from time to time by the Secretary-treasurer fifteenth {15th} of the Communications Workers of America as his/her duly authorized agentmonth) for the month the dues are being paid. 10. This authorization may be revoked Any employee whose seniority is broken by me at any time by written request death, quit, discharge or layoff, or who is transferred to a position outside the Employer and by sending a copy of such request to the Secretary-treasurer of the Union. Union membership dues and agency fees are not deductible as charitable contributions for Federal income tax purposes. Dues and agency fees, however, may be deductible in limited circumstances subject to various restrictions imposed by the Internal Revenue Code. Resident Address Signature of Employee City/Town State Zip Code Social Security Number Date of Birth Date Received by Company Date Effective During the negotiations that resulted in this Agreement, the parties agreed to delete the job titles of staff development/patient educator and case manager from the inclusion language outlined in Article 3, Section 1., and to include those same job titles under the exclusion language in Article 3, Section 1. The intent of this change is to ensure that the inclusion language accurately reflects the current composition scope of the bargaining unit, shall cease to be subject to check-off deductions beginning with the month immediately following that in which such death, quit, discharge, layoff, or transfer occurred. 11. It was In the event any employee shall register a complaint with the Employer alleging his/her dues are being improperly deducted, the employer will make no further agreed deductions of the employee's dues. Such dispute shall then be reviewed with the employee by a representative of the Union and a representative of the Employer. 12. The Employer shall not be liable to the Union by reason of the requirements of this Check-Off Agreement for the remittance of payment of any sum other than that constituting deduction made from employee wages earned. 13. The Union shall indemnify, defend and save the Employer harmless against any and all claims, demands, suits or other forms of liability that shall arise out of or by reason of action taken by the parties, that if St. ▇▇▇▇▇▇ Campus were to re-employ nurse educators or case managers, the job titles and the employees hired to work Employer in those job titles would return reliance upon payroll deduction authorization cards submitted to the bargaining unitEmployer. BOOTH CASHIERS - The Company will have full and extensive training on the handling of traveler's checks. Discipline can only occur in regard to traveler's checks if an employee does not follow the established procedure.

Payroll Deduction Authorization. NAME JOB TITLE The undersigned hereby authorizes Sisters of Charity Hospital to deduct from my wages: CHECK EITHER: MEMBER The monthly dues and one initiation fee as certified to the Employer from time to time by the Secretary-treasurer of the Communications Workers of America, America and remit same to the Secretary-treasurer of the Communications Workers of America as his/her duly authorized agent. This authorization may be revoked by me at any time by written request to the Employer and by sending a copy of such request to the Secretary-treasurer of the Union, or AGENCY FEE PAYER A service charge equal to the monthly dues as certified to the Employer from time to time by the Secretary-treasurer of the Communications Workers of America as his/her duly authorized agent. This authorization may be revoked by me at any time by written request to the Employer and by sending a copy of such request to the Secretary-treasurer of the Union. Union membership dues and agency fees are not deductible as charitable contributions for Federal income tax purposes. Dues and agency fees, however, may be deductible in limited circumstances subject to various restrictions imposed by the Internal Revenue Code. Resident Address Signature of Employee City/Town State Zip Code Social Security Number Date of Birth Date Received by Company Date Effective During the negotiations that resulted in this Agreement, the parties agreed to delete the job titles of staff development/patient educator and case manager from the inclusion language outlined in Article 3, Section 1., and to include those same job titles under the exclusion language in Article 3, Section 1. The intent of this change is to ensure that the inclusion language accurately reflects the current composition of the bargaining unit. It was further agreed by the parties, that if St. ▇▇▇▇▇▇ Campus were to re-employ nurse educators or case managers, the job titles and the employees hired to work in those job titles would return to the bargaining unit.Effective

Payroll Deduction Authorization. NAME JOB TITLE The undersigned Hire Date Current Date For The: University of Michigan By: (Last Name) (First Name) (Middle) Effective: , 20 . (Starts the first payroll of the month) I hereby authorizes Sisters of Charity Hospital request and authorize you to deduct from my wagesearnings once each month, an amount established by the Union as monthly dues. The amount deducted shall be paid to: CHECK EITHERSignature: MEMBER The monthly dues and one Mailing Address: Number Street City Zip Pick One - Union Dues or Service Fee (Initials) (Initials) 128 University of Michigan, Command Officer’s Association Any new employee may pay the initiation fee as certified of Twenty Dollars ($20.00). Any member of U-M, COA who returns to the Employer from time Association after leaving the Association shall not have to time by pay the Secretary-treasurer of the Communications Workers of Americainitiation fee, and remit same if said employee returns to the SecretaryAssociation within three years (3) of leaving this Association, known as U-treasurer of the Communications Workers of America as his/her duly authorized agentM COA. Signature: ▇▇▇▇▇▇▇: EMAIL Address: This authorization may form shall be revoked hand delivered to University Human Resources @ Wolverine Tower by me at any time by written request to the Employer and by sending a copy of such request to the Secretary-treasurer of the Union, or AGENCY FEE PAYER A service charge equal to the monthly dues as certified to the Employer from time to time by the Secretary-treasurer of the Communications Workers of America as his/her duly authorized agent. This authorization may be revoked by me at any time by written request to the Employer and by sending a copy of such request to the Secretary-treasurer of the Union. Union membership dues and agency fees are not deductible as charitable contributions for Federal income tax purposes. Dues and agency fees, however, may be deductible in limited circumstances subject to various restrictions imposed by the Internal Revenue Code. Resident Address Signature of Employee City/Town State Zip Code Social Security Number Date of Birth Date Received by Company Date Effective During the negotiations that resulted in this Agreement, the parties agreed to delete the job titles of staff development/patient educator and case manager from the inclusion language outlined in Article 3, Section 1., and to include those same job titles under the exclusion language in Article 3, Section 1. The intent of this change is to ensure that the inclusion language accurately reflects the current composition of the bargaining unit. It was further agreed by the parties, that if St. ▇▇▇▇▇▇▇ Campus of COAM where a copy of this document will be stamped by an authorized person and retained by COAM. Rev: 04/15 129 Payroll deductions shall be made only from the pay due employees on the last pay day of each calendar month. The initial deduction for any employee, however, shall not begin unless both (1) a properly executed “Voluntary Authorization for Deduction of Union Dues or Service Charge”; and (2) the amount of the monthly membership dues or service charge certified by the Financial Secretary of the Union has been delivered to the University at a place designated by the University at least thirty (30) calendar days prior to the last pay day of the calendar month. Changes in the amount of the monthly membership dues or service charge also must be delivered to the University at a place designated by the University, at least thirty (30) calendar days prior to the last pay day of the calendar month before the change will become effective. 130 An employee may revoke his/her “Voluntary Authorization for Deduction of Union Dues or Service Charge” at any time by written notification to the University on a form provided by the University. Payroll deductions shall terminate when a revocation has been delivered to the University at least thirty (30) calendar days prior to the last pay day of the calendar month. 131 All sums deducted by the University shall be remitted to the Financial Secretary of the Union at an address given to the University by the Union, once each month by the fifteenth (15th) calendar day of the month following the month in which the deductions were made, together with a list of names and the amount deducted for each employee for whom a deduction was made and names of employees for whom no deduction was made. The University will also notify the Union of the name of each employee who revokes his/her “Voluntary Authorization for Deduction of Union Dues or Service Charge.” 132 The University shall not be liable to re-employ nurse educators the Union by reason of the requirements of this Article for the remittance or case managerspayment of any sum other than that constituting actual deductions made from the pay earned by the employee. In addition, the job titles Union shall indemnify and save the employees hired to work University harmless from any liability resulting from any and all claims, demands, suits or any other action arising from compliance with this Article, or in those job titles would return to the bargaining unitreliance on any list, notice, certification or authorization furnished under this Article.