Fillable Employee Payroll Deduction Authorization Form For Criminal Background (Pensacola State College)

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Employee Payroll Deduction Authorization Form For Criminal Background (Pensacola State College)

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Employee Payroll Deduction Authorization Form
For Criminal Background Checks
Name:____________________________________________________________________
Address:___________________________________________________________________
City, State and Zip:__________________________________________________________
Employee ID:____________________ Department:_____________________________
Phone Number:___________________ Email:___________________________________
I understand that pursuant to College policy, it is an employment eligibility requirement for an
applicant to meet the requirements of § 435.04(2), Florida Statutes, related to background
investigations. Any person failing to meet the requirements of the statute will be deemed not
qualified to hold employment. A Florida Department of Law Enforcement (FDLE) approved
background check will be conducted on every successful candidate as a condition of employment,
and any person who fails to disclose any adverse information contained in the background
investigation at the time of submitting an employment application will be disqualified from
employment. Please reference the Board of Trustees' Policy, 6Hx20.1.036 for further
information.
I authorize a one-time deduction of $37.25 from my paycheck.
Signature:
Date:
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
FOR HUMAN RESOURCES: Code #
Record Updated by:
Date:
01/2019
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Employee Payroll Deduction Authorization Form For Criminal Background (Pensacola State College)

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Completed 25 August 2020

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