Payroll Wage Withholding Authorization - SHRM
A sample form to document authorization of payroll deductions.
I understand and agree that any amount that is due and owing at the time of my termination, regardless of whether my termination was voluntary or not, will be deducted from my last paycheck or any other amounts that may be owed to me. This authorizes my employer to retain the entire amount of my last paycheck in compliance with the law.
I understand and agree that any amount that is due and owing at the time of my termination, regardless of whether my termination was voluntary or not, will be deducted from my last paycheck or any other amounts that may be owed to me. This authorizes my employer to retain the entire amount of my last paycheck in compliance with the law.
I, [Your Name], hereby authorize [Company/Organization Name] to make payroll deductions from my salary/wages for [Specify Purpose, e.g., health insurance, retirement contributions], effective from [Start Date] until further notice.
Payroll deduction authorization form in Word and Pdf formats
Download or preview 1 pages of PDF version of Payroll deduction authorization form (DOC: 63.4 KB | PDF: 37.6 KB ) for free.
☐ FREQUENTLY RECURRING DEDUCTIONS: Not to exceed $ per paycheck without additional authorization for (Ex: food, tools, supplies, phone, etc.) ☐ SUPPLIES OR EQUIPMENT PURCHASE: $ per paycheck for the next paycheck(s)
authorizes the Company to make a payroll deduction to cover the cost of replacement. *Loan/Advance of Wages must complete this Section: I agree to have $__________________ deducted from each paycheck for ______ number of pay
- 某些结果已被删除