LAMAR STATE COLLEGE-PORT ARTHUR
Salary Spread Election Form
Request for 9-month salary to be spread over 12 months in equal installments:
I hereby request and authorize that my nine (9) month salary for both regular semesters
be paid to me in twelve (12) equal installments.
I understand and agree that this plan of payment cannot be changed during the twelve
month period unless my employment with the College is terminated. If I terminate
employment, all deferred salary will be paid to me on my next paycheck which could
increase my tax withholding percentage for that month. I can only change this election
prior to September 1 of any year, to be effective September 1. I also understand and
agree that TexFlex and insurance deductions will be made on a twelve-month
installment basis.
Request to change my 12-month salary spread back to a 9-month basis:
I hereby request and authorize that my current twelve (12) month salary spread be
changed back to a nine (9) month pay basis.
I understand and agree that unless I work during the two summer sessions, no insurance
deductions will be made and that I must pay my insurance premiums to Payroll in order
to continue my insurance during the summer months. I further understand that my
failure to pay these insurance premiums will result in my insurance being cancelled and
that if I later wish to re-enroll in the College insurance programs, I must wait until an
open enrollment and may be subject to evidence of insurability requirements (coverage
may be denied by the insurance company).
For this election to be effective,
I
understand that this form
must
be received
in
Human
Resources no later than August 31.
I acknowledge being notified that, with exceptions, I have the right to be informed of and to
receive, review, and, if necessary, correct the information that Lamar State College-Port Arthur
collects on me
.
Please sign below and return this form to Human Resources, Business Office, Room 121. For
more information, please call (409) 984-6237 or e-mail Rileytl@lamarpa.edu.
Signature of Employee: Date:
Print Name: LSC-PA ID
Lamar State College - Port Arthur is a member of The Texas State University System.
