Fillable Form 928: HUMAN RESOURCES DEPARTMENT (Town of Payson)

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Form 928: HUMAN RESOURCES DEPARTMENT (Town of Payson)

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The Form 928: HUMAN RESOURCES DEPARTMENT (Town of Payson) form is 1 page long and contains:

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  • 13 check-boxes
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Country of origin: US
File type: PDF

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HUMAN RESOURCES DEPARTMENT
______________________________________________________
EMPLOYEE DIRECT DEPOSIT AUTHORIZATION
**MUST attach a VOIDED check or a Direct Deposit Form from your Financial Institution**
Employee Name: ___________________________________________ Date: _____________
Name as Appears on Bank Account: ________________________________________________
I HEREBY: AUTHORIZE CHANGE CANCEL
100% NET DEPOSIT:
BANK NAME: ________________________________________________________________
ROUTING #: ACCOUNT #:
CHECKING ACCOUNT SAVINGS ACCOUNT
MULTIPLE ACCOUNTS:
BANK NAME: ________________________________________________________________
ROUTING #: ACCOUNT #:
CHECKING ACCOUNT FIXED DOLLAR AMOUNT: $__________
SAVINGS ACCOUNT PERCENTAGE: ____________%
BANK NAME: ________________________________________________________________
ROUTING #: ACCOUNT #:
CHECKING ACCOUNT FIXED DOLLAR AMOUNT: $__________
SAVINGS ACCOUNT PERCENTAGE: ____________%
MELANIE BAIRD-SIMMONS, HR MANAGER X5011
E-
MAIL mbaird-simmons@paysonaz.gov
K
ELLI SCHWEIN, HR ANALYST X5012
E-
MAIL kschwein@paysonaz.gov
K
ATHERINE JOST, PAYROLL SPECIALIST X5013
E-MAIL kjost@paysonaz.gov
TOWN OF
303 N BEELINE HWY
P
AYSON, AZ 85541
(
928
)
474-5242 FAX
(
928
)
474-1151
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Form 928: HUMAN RESOURCES DEPARTMENT (Town of Payson)

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Completed 9 February 2021

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