Employee'S Authorization printable pdf download

Employee'S Authorization

FOR PAYROLL USE ONLY:

MADISON CITY SCHOOLS

211 CELTIC DRIVE

Employee #: ________________

MADISON, AL 35758

Deduction #: ________________

PHONE: 256-464-8370

FAX: 256-464-8291

Date Processed: ______________

DIRECT DEPOSIT

All Madison City employees are required to participate in the Direct Deposit program and

view their earnings statements online at

https://dsv.madisoncity.k12.al.us/employeeselfservice/.

RETURN COMPLETED AUTHORIZATION TO THE PAYROLL DEPARTMENT

YOUR CHECK WILL NOT DIRECT DEPOSIT UNTIL THE 2

PAYROLL

FOLLOWING THE PROCESSING OF THIS AUTHORIZATION

EMPLOYEE’S AUTHORIZATION

Printed Name: _________________________________ SSN: _______________________

E-Mail Address: _____________________________________________________________

I hereby authorize Madison City Schools and my financial institution to (check one):

_____ Deposit my entire net check into the checking or savings account listed below

_____ Change the checking or savings account previously authorized to the new account

listed below

_____ Temporarily inactivate my direct deposit pending new account information

Bank Name: ________________________________________________________________

Account Type:

( ) Checking

( ) Savings

YOU MUST ATTACH A VOIDED CHECK OR ACCOUNT

DOCUMENTATION FROM YOUR FINANCIAL INSTITUTION

I give Madison City Schools authority to initiate electronic credit entries, and if

necessary, debit entries and adjustments for any credit entries in error. I understand

it is my responsibility to inform the Payroll Department of any changes to my account.

Employee’s Signature: ___________________________ Date: ____________________

Employee'S Authorization