AUTHORIZATION FOR PAYROLL DEDUCTION
AUTHORIZATION FOR PAYROLL DEDUCTION
The undersigned does hereby authorize the Rowan-Salisbury School System
To deduct the amount of $________________________________________
From his/her gross earnings each payroll beginning____________________
In payment for_________________________________________________
As per agreement, these deductions will continue until the above obligation is paid in full or until employment with Rowan-Salisbury Schools is terminated for any reason. Should employment be terminated prior to the payment in full of this obligation, the undersigned agrees to pay the balance owed on or before the termination date.
Name________________________________________________________
Social Security #_______________________________________________
School Location________________________________________________
Signature_____________________________________________________
Date_________________________________________________________
Please return to the payroll department or fax to 704-630-6012.
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