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 Memorandum of Understanding #1 Recognition 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. Xxxxxx 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 hereby authorizes Sisters Deductions from your paycheck may be part of Charity Hospital the Services you obtain from Even, if such deduction is authorized by the law of the state in which you work and if you authorize your employer to deduct from my wages: CHECK EITHER: MEMBER The monthly dues make such deductions. You acknowledge that, as applicable, the payroll deduction authorization contained in this Section represents your written authorization for payroll deductions as provided herein and one initiation fee as certified will remain in full force and effect until you notify Even that you wish to revoke this authorization by emailing xxxxxxx@xxxx.xxx. YOU MUST NOTIFY EVEN AT LEAST THREE 3 BUSINESS DAYS BEFORE THE SCHEDULED PAYMENT TRANSFER DATE IN ORDER TO CANCEL THIS AUTHORIZATION. When you email, please include the name and telephone number associated with your Even Account. Failure to provide correct and complete information may make it impossible for Even to stop withdrawal of the preauthorized withdrawal. You agree to indemnify and hold harmless Even or Employer from time to time by the Secretary-treasurer and against any loss incurred as a result of its withdrawal of a payroll deduction authorization if any of the Communications Workers information relied upon in your request to stop payment is incorrect or incomplete. If you have followed the instructions in this section to notify Even of Americayour desire to revoke your authorization at least three (3 business days before the scheduled payroll deduction date, Even will be liable for your losses or damages directly caused by our failure to stop any payroll deduction. If Even does not receive notice at least three (3 business days before the payroll deduction date, Employer may attempt, in its sole discretion, to cancel the transaction. However, Employer assumes no responsibility for its failure to do so. For further information regarding payroll deductions, your authorization for payroll deductions, and remit same insufficient funds from your paycheck 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 Unioncover Instapay repayment, Automatic Save allocations, or AGENCY FEE PAYER A service charge equal to the monthly dues as certified to the Automatic Payments allocations, please see your 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 Memorandum of Understanding #1 Recognition 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. Xxxxxx 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 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 Memorandum of Understanding ## 1 Recognition 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. Xxxxxx 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.. Memorandum of Understanding # 2 On-Call Digestive Health 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 EITHERCOAM 00000 Xxx Xxxx, Xxxxxxx, XX 00000-0000 Signature: 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 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 M COA. Signature: Xxxxxxx: EMAIL Address: (Optional) This form shall be hand delivered to University Human Resources @ Wolverine Tower by a Xxxxxxx 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 COAM where a copy of such request to this document will be stamped by an authorized person and retained by COAM. Rev: 04/15 15-2 Payroll deductions shall be made only from the Secretary-treasurer pay due employees on the last pay day 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 agenteach calendar month. This authorization may be revoked by me at The initial deduction for 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 feesemployee, however, may be deductible in limited circumstances subject to various restrictions imposed 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 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 Memorandum of Understanding #1 Recognition 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 Financial Secretary of the bargaining unit. It was further agreed Union has been delivered to the University at a place designated by the parties, that if St. Xxxxxx 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 University at least thirty (30) calendar days prior to the bargaining unitlast 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 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 EITHERCOAM 00000 Xxx Xxxx, Xxxxxxx, XX 00000-0000 Signature: 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 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 Association after leaving the Association shall not have to pay the initiation fee, if said employee returns to the Association within three years (3) of leaving this Association, known as U-M COA. Signature: Xxxxxxx: EMAIL Address: (Optional) This form shall be hand delivered to University Human Resources @ Wolverine Tower by a Xxxxxxx 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 time to time 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 Secretary-treasurer Financial Secretary of the Communications Workers of America, and remit same Union has been delivered to the Secretary-treasurer University at a place designated by the University at least thirty (30) calendar days prior to the last pay day of the Communications Workers calendar month. Changes in the amount of America as 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 duly authorized agent. This authorization may be revoked by me “Voluntary Authorization for Deduction of Union Dues or Service Charge” at any time by written request notification to the Employer and University on a form provided by sending the University. Payroll deductions shall terminate when a copy of such request revocation has been delivered to the Secretary-treasurer 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, or AGENCY FEE PAYER A service charge equal to the monthly dues as certified to the Employer from time to time once each month by the Secretary-treasurer fifteenth (15th) calendar day of the Communications Workers month following the month in which the deductions were made, together with a list of America as 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 duly authorized agent. This authorization may “Voluntary Authorization for Deduction of Union Dues or Service Charge.” 132 The University shall not be revoked by me at any time by written request liable to the Employer and Union by sending a copy of such request to the Secretary-treasurer reason of the Union. Union membership dues and agency fees are not deductible as charitable contributions requirements of this Article for Federal income tax purposes. Dues and agency fees, however, may be deductible in limited circumstances subject to various restrictions imposed the remittance or payment of any sum other than that constituting actual deductions made from the pay earned by the Internal Revenue Codeemployee. Resident Address Signature of Employee City/Town State Zip Code Social Security Number Date of Birth Date Received by Company Date Effective Memorandum of Understanding #1 Recognition During the negotiations that resulted in this AgreementIn addition, the parties agreed to delete Union shall indemnify and save the job titles of staff development/patient educator University harmless from any liability resulting from any and case manager all claims, demands, suits or any other action arising from the inclusion language outlined compliance with this Article, or in Article 3reliance on any list, Section 1notice, certification or authorization furnished under this Article., 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. Xxxxxx 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.