Chesapeake Public Schools
1. Use this form to initiate the direct deposit of your net pay.
2. If your bank account is a CHECKING account, attach a check marked "VOID" to this sheet.
3. If your bank account is a SAVINGS account, attach a pre-printed DEPOSIT slip with your accoun
information OR obtain the routing and account information from your bank and complete the appropriate
boxes below.
4. See second page for additional information and terms concerning Direct Deposit.
Please print or type
Employee Name (Please Print-First, MI, Last) Employee ID Number
Daytime Phone Number School/Building Employee Social Security Number
Name of Depository Bank, Credit Union, Financial Institution
New Change Stop
Effective Date
/ /
Attach voided
check (if checking
account) or
preprinted deposit
slip (if savings
account) here.
Bank/Transit/ABA Routing Number Depositor Account Number
Checking Savings
I certify that the above account bears my name and that I am an unrestricted and authorized signor on the account.
I authorize Chesapeake Public Schools and the financial institution named above to deposit the assigned amount of my
pay and or any reimbursements automatically into my checking or savings account each payday. If money to which
I am not entitled is deposited into my account, I authorize Chesapeake Public Schools to direct the financial institution
to return those funds. I have read the information about direct deposit on the second page of this form.
Signature of Employee _____________________________________________________
For Payroll Use Only: First Prenote:_______________Input by:________________________Date:_______________
Chesapeake Public Schools
You must provide accurate and legible bank information; any inaccuracies may result in a failed direct deposit and
a delay in your pay. To ensure that your pay is deposited on time, have your bank verify the routing and account
If direct deposit is to a checking account, a deposit slip cannot be substituted for a voided check because deposit
slips may not have all the bank routing information needed for direct deposit.
If you decide to use an account such as a money market account from a brokerage or mutual fund company, you
should contact the company and request their bank/transit/ABA routing number and your individual account
You may receive checks for one or two pay periods after submitting this form. You should not, however, receive
checks for more than two pay periods.
Your pay advice or pay stub portion of your check provides detailed information about your pay, deductions, leave
balances and direct deposits.
Your net pay will be deposited on payday. Your net pay may vary from one pay period to the next depending on
changes in your pay, deductions, tax rates, hours worked, etc.
You should check with your bank each pay period to ensure that the direct deposit was made prior to making
funancial transactions that are dependent on those funds.
If you wish to change banks or bank accounts, change deposit amounts, or stop a direct deposit, you must submit a
new direct deposit authorization form 30 days prior to when the changes will be effective.
It is recommended that you verify your direct deposit information if you change your employment status as your
direct deposit information may be invalid (for example, medical leave, leave of absence, etc.).
If you have questions about how to complete the form or about the direct deposit program, please contact the
Payroll Department at (757) 547-0465.
Return form by pony or by U.S. Mail to:
Chesapeake Public Schools
Payroll Department
P.O. Box 16496
Chesapeake, VA 23328