Uscis Form I-9 - Employment Eligibility Verification Page 10
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12BELHAVEN UNIVERSITY
Student Employment - Payment Authorization Form
Student Employee Name: ___________________________ Social Security Number: ___________________
Belhaven Email Address: ___________________________ Phone Number: ________________________
I authorize Belhaven University to pay my student employment earnings by the following method checked below.
_____ Apply my earnings directly to my student account.
I hereby authorize Belhaven University to initiate credit entries to my Belhaven University Student Account.
_____ Issue a paper payroll check.
_____ Direct Deposit to my personal bank account.
Account Type
Name of
(Check One)
Financial Institution
Bank Routing Number
Bank Account Number
___ Checking Account
(or)
___ Savings Account
Attach a voided check – not a deposit slip. If depositing to a savings account, ask your bank to give you a letter with the
Routing/Transit Number and your Account Number. This will help ensure that you are paid correctly.
I authorize Belhaven University and the bank listed above to deposit my pay electronically to my bank account each payday. If funds to
which I am not entitled are deposited in my account, I hereby authorize Belhaven University to direct the bank to return said funds to
Belhaven University.
The above checked payment method is to remain in effect until Belhaven University has received written notification from me of its termination.
___________________________________________
______________________________
Student Signature
Date
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