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Pennsylvania Payroll Deduction Authorization

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Pennsylvania Payroll Deduction Authorization Powered By Docstoc
					                                                              Payroll Deduction
                                                              Authorization
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                          This Payroll Deduction Authorization Notice can be used by a
                          Company/Employer to withhold an amount from Employee’s earning. It is
                          an authorization form for employee to sign for deductions.




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                        PAYROLL DEDUCTION AUTHORIZATION

Company/Department: ____________________ [Instruction: Insert the name of Company]

Employee Name: _________________________ [Instruction: Insert the name of Employee]

Employee ID Number: _______________ [Instruction: Insert Employee ID number (if any)]

Work E-mail Address: _______________ [Instruction: Insert E-mail address of Employee]

Work Telephone Number: __________ [Instruction: Insert telephone number of Employee]

Deduction Effective Date:       ____ [Month] ____ [Date], 20__

1. I hereby authorize _________________ [Instruction: Insert the name of Company] to
   initiate a payroll deduction to deduct ________ ($___) [Instruction: Insert the Deduction
   amount, e.g., fifty dollars ($50)] per pay period from my paycheck, effective with the pay
   date of ____ [Month] ____ [Date], 20____ for any compensation that may be due to me up
   to and including the total amount of any of the following:

Payroll Deduction Codes:

(Under Pennsylvania Code, [STATUTE])

       a. Uniform usage fee, if required by Company. Reasonable replacement costs of keys,
          training manuals, tools, supplies, uniforms, etc. supplied to me by the Company,
          which are not returned upon request.

       b. Education expense reimbursed to me by employer, if termination occurs within
          ______ (___) [◊six (6)] months of completion of the course. Stop payment fees for
          lost or destroyed payroll checks.

       c. Drawer Shortage that is under my supervision and control as allowable by State
          jurisdiction.

       [Instruction: Please amend th
				
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Description: This Payroll Deduction Authorization Notice can be used by an employer to withhold an amount from an employee's earnings. A payroll deduction plan offers employees a convenient way to automatically contribute income toward an ongoing expense. Typically, the funds are put towards insurance, healthcare or an investment account. This authorization form contains standard provisions and it may be customized to address the specific needs of the employer or employee. This document should be used by employers located in Pennsylvania that offer a payroll deduction plan to employees.
This document is also part of a package Essential Pennsylvania Legal Documents 86 Documents Included