Authorization To Deposit Salary Check In Employee'S Bank
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1Substitute
Classified
Certificated
AUTHORIZATION TO DEPOSIT SALARY CHECK IN EMPLOYEE’S BANK
TO: PAYROLL DEPARTMENT
The Jefferson County Board of Education is authorized to deposit my salary check directly to my bank
account or savings account, as indicated below in the regular monthly payroll. This authorization is
continuous and should not be stopped until such time as written notice is given to do so. A PRE-NOTE
WILL BE DONE ON ALL DIRECT DEPOSITS, MEANING THE FIRST MONTH YOU ARE
ENROLLED OR MAKE A CHANGE YOU WILL CONTINUE TO RECEIVE A CHECK
UNTIL VERIFICATION IS MADE BY THE BANK. A copy of a voided check must accompany
this form. IF A VOIDED CHECK OR LETTER FROM THE BANK IS NOT INCLUDED, THE
DIRECT DEPOSIT WILL NOT BE ENTERED.
Name as shown on
______________________________________________________
Payroll check
(Please Print)
Employee # (Preferred) / SS# ________________________________________________
Address
______________________________________________________
______________________________________________________
Daytime Phone Number
________________________________________________
School (Subs leave blank) __________________________________________________
Name as shown on
______________________________________________________
Bank Account
Bank Account Number
YOU MUST ATTACH A VOIDED CHECK OR BANK LETTER
Type of Account
Checking
Savings
Debit
If the account type is a savings account or
a prepaid debit card, or if the attached voided check does not contain a preprinted name and
address, a letter from your bank containing account name, routing number and account number
must be attached.
Signature________________________________________________
Date ________________
Information must be received in the Payroll Department by the 15th of the month in order to be on the
pre-note direct deposit for the pay period and direct deposit for the following month.
________________________________________________________________________________
Office use only
Mail to:
Jefferson County Board of Ed
Bank Deduction Number __ __ __
Attn: Payroll Dept
th
Date Entered _____________
2100 18
Street South
Entered By _____________
Birmingham, Al 35209-1891
Rev. 9/24/08
Fax to:
(205) 379-2307 (Original must
follow in the mail)
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