Payroll Deduction Authorization - TDHCA
PAYROLL DEDUCTION AUTHORIZATION
SUBRECIPIENT: Contract No:
CONTRACTOR NAME:
EMPLOYEE’s CERTIFICATION:
I, hereby authorize
(employee name) (contractor name)
to deduct $ from my paycheck.
This deduction pays for: (Mark all appropriate types)
| Loan Repayment | Retirement | Profit Sharing | Advance |
| Uniforms | 401K | Tools | Materials |
| Charitable Donations | Insurance Premiums | Savings Bonds | Union Dues |
| Other: |
When does this deduction happen? (Mark all appropriate times)
| One time only | Weekly | Monthly | times for weeks |
| Other: |
Employee's Name:
Address:
City: State:
Zip: Telephone Number: ( )
Employee's Signature: Date:
OWNER’s CERTIFICATION:
I, hereby certify that the voluntary deductions above
(Project Owner/ Contractor)
will not reduce the hourly rate paid to this employee below the federal minimum hourly rate of $7.25.
Employer’s Name:
Address:
City: State:
Zip: Telephone Number: ( )
Employer's Signature: Date:
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related searches
- voluntary payroll deduction form template
- free printable payroll deduction forms
- benefit payroll deduction form
- blank payroll deduction forms
- generic payroll deduction form
- employee payroll deduction authorization form
- payroll deduction authorization agreement
- payroll deduction form template
- authorization for payroll deduction template
- free payroll deduction authorization form
- sample payroll deduction form
- employee payroll deduction agreement form