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
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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.
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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)
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PAYROLL DEDUCTION AUTHORIZATION FORM. As a payroll deductions xxxxxx, I hereby: 1) Authorize the Office of Parking Services to STOP my payroll deductions.
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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.
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PAYROLL DEDUCTION AUTHORIZATION FORM. This is to authorize eighteen (18) equal deductions annually from my pay for dues in the amount of $ for the Southeast Delco Federation of Support Staff. This authorization will remain in effect unless canceled in writing fifteen (15) days prior to the expiration of the collective bargaining agreement in effect on this date.
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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 deducted. Such remittance shall be made by the tenth (10 ) day of the succeeding month.
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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:
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PAYROLL DEDUCTION AUTHORIZATION FORM. As a payroll deductions xxxxxx, I hereby:
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Related to PAYROLL DEDUCTION AUTHORIZATION FORM

  • Payroll Deduction Schedule The Board will deduct the representation fee in equal installments, as nearly as possible, from the paychecks paid to each employee on the aforesaid list during the remainder of the membership year in question. The deductions will begin with the first paycheck paid:

  • Other Payroll Deductions Upon appropriate written authorization from the employee, the Board shall deduct from the salary of any employee and make appropriate remittance for annuities, credit union, savings bonds, insurance, or any other plans or programs approved by the parties.

  • 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. B. OCEA shall notify the County, in writing, as to the amount of dues uniformly required of all members of OCEA and also the amount of insurance premiums required of employees who choose to participate in such programs.

  • 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. 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).

  • INSTRUCTIONS FOR COMPLETING REPAYMENT ELECTION FORM AND EXERCISING REPAYMENT OPTION Capitalized terms used and not defined herein have the meanings defined in the accompanying Repayment Election Form.

  • PAYROLL DEDUCTION OF DUES 12.01 The Company shall deduct from the payroll of employees on each pay period, from wages due and payable to all employees coming within the scope of this agreement, an amount as provided by the Union, subject to the conditions described below. 12.02 The amount to be deducted shall be equivalent to the regular dues payment of the Union and may include initiation fees, fines, or special assessments. The amount to be deducted will only be changed during the term of the agreement to conform to a change in the amount of regular dues of the Union in accordance with its constitutional provisions. 12.03 If the wages of an employee payable on the payroll for the last pay period of any month are insufficient to permit the deduction of the full amount of dues, no such deduction shall be made from the wages of such employee by the Company in such month. The Company shall, because the employee did not have sufficient wages payable to him on the designated payroll, carry forward and deduct from any subsequent wages the dues not deducted in an earlier month. 12.04 Only payroll deductions now or hereafter required by law, as well as benefit and pension deductions, shall be made from wages prior to the deduction of dues. 12.05 The amount of dues so deducted from wages accompanied by a statement of deductions from individuals, shall be remitted by the Company to the Union as may be mutually agreed by the Union and the Company, not later than thirty (30) calendar days following the month in which the deductions were made. 12.06 The Union agrees to indemnify and save the Company harmless against any claim or liability arising out of the application of this article. However, in any instances in which an error occurs in the amount of any deduction of dues from an employee’s wages, the Company shall adjust the amount in a subsequent remittance. 12.07 The Union will provide the Company with a percentage or other amount of basic wages to be applied for the purpose of dues deductions.

  • Enrollment Period Educational Support Professionals may elect to participate in the Career Transition Trust annually during a two (2) week enrollment period determined by the District, but that will occur no later than May 1st each year, provided they have met the eligibility requirements for participation in Subdivision. 2.

  • Notification of Absence A unit member shall contact the office of the division xxxx whenever there is a need to be absent and at least thirty (30) minutes prior to missing any work assignment. Should circumstances prohibit this notification, the unit member shall notify the division office in writing, within one week of returning to work, providing the reasons why advance notification was not given.

  • 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.

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