SOUTHEASTERN LOUISIANA UNIVERSITY
PAYROLL DEDUCTION AUTHORIZATION
I hereby authorize Southeastern Louisiana University to deduct from my
salary until further notice the amount of ___________________ per pay
period for deposit in the
SOUTHEASTERN DEVELOPMENT FOUNDATION
Phi Kappa Phi Endowed Scholarship
Restrictions (if any) |
________________________________________
Employee’s Dept./Phone No. |
I further, hereby waive on behalf
of myself, my heirs, successors, and assign any and all rights of action
against Southeastern Louisiana University and/or the State of Louisiana
(and any officer, employee or agency thereof) arising out of the deduction,
nondeduction, processing, or any other handling of the named voluntary
deduction.
| Employee Signature |
______________________________________________________ |
| Address |
______________________________________________________ |
| City, State, Zip |
______________________________________________________ |
| EMPLOYEE NAME |
___________________________________________________________ |
| PEOPLESOFT EMP. ID |
___________________________________________________________ |
| SOCIAL SECURITY # |
___________________________________ |
EFFECTIVE DATE _________ |
| VENDOR NAME |
SOUTHEASTERN DEVELOPMENT FOUNDATION |
| BENEFIT PLAN |
DEVELOPMENT FOUNDATION |
FOR OFFICE USE ONLY:
CAFETERIA PLAN ITEM:
YES _________ NO _________ N/A ____X____
| ANNUAL AMOUNT |
_____________________ |
MONTHLY AMOUNT |
_____________________ |
| GOAL AMOUNT |
_____________________ |
BIWEEKLY AMOUNT |
_____________________ |
| BEGINNING DATE: |
_____________________ |
1st PAYDAY IN: |
_____________________ |
|
|
2nd PAYDAY IN: |
_____________________ |
VENDOR
SIGNATURE _____________________________________________
DATE ________________
THIS FORM SUPERSEDES AND REPLACES
ALL PRIOR AUTHORITY FOR THIS DEDUCTION
PAYROLL ___________________
POSTED BY: _______________ DATE ________________ |