Employee Salary Advance Agreement

EMPLOYEE SALARY ADVANCE AGREEMENT

Parties and Effective Date

This Employee Salary Advance Agreement (the Agreement) is entered into between Employer Name: with business address: and Employee Name: .

Employee Personal Information

Position Information

Employment Start Date:

Employment History

Education

Graduation Date:

References (Professional)

Advance Request and Repayment Terms

Advance Amount: $   Requested Disbursement Date:

Repayment Method: Payroll deduction authorized   If not payroll deduction, describe alternate method:

Repayment Start Date:

Repayment Amount per Pay Period: $   Expected Number of Payments:

Interest and Fees: The advance shall bear interest per annum and Employee agrees to pay any administrative fee of $ unless otherwise agreed in writing.

Security, Default and Remedies

Security: To secure repayment, Employee authorizes Employer to deduct the unpaid balance from final wages, severance, or other amounts otherwise payable to Employee, to the extent permitted by applicable law.

Default: Employee will be in default if Employee fails to make required repayment(s), terminates employment prior to full repayment, or otherwise breaches this Agreement. Upon default, Employer may accelerate the balance and pursue any lawful remedies, including collection and legal costs. Employer will provide written notice of default to Employee at the address on file prior to taking collection action where required by law.

Tax Withholding and Deductions

All repayments and any related taxable benefit shall be subject to applicable tax withholdings and deductions. Nothing in this Agreement is intended to change Employee's tax status. Employee acknowledges that Employer may report the advance and any taxable portion to tax authorities as required by law.

Notices

Notices to Employer shall be sent to:

Notices to Employee shall be sent to the Home Address provided above unless Employee notifies Employer in writing of a different address.

Employee Acknowledgements and Authorizations

I certify that all information provided in this Agreement is true and complete to the best of my knowledge. I authorize Employer to verify any information provided, contact prior employers and references, and to make payroll deductions as set forth in this Agreement. I understand that consent to payroll deduction for repayment is a condition of this advance unless an alternative payment arrangement is approved in writing by Employer.

At-Will Employment: Employee acknowledges that nothing in this Agreement constitutes a promise of continued employment. Employment remains at-will, meaning either Employer or Employee may terminate the employment relationship at any time, with or without cause, subject to applicable law and any separate written agreement.

Equal Opportunity: Employer is an equal opportunity employer. Decisions concerning salary advances will be made in accordance with applicable nondiscrimination laws and Employer policies.

Miscellaneous

Amendment: This Agreement may be amended only by a written instrument signed by both parties. Governing Law: This Agreement will be governed by the laws of the state applicable to Employer's principal place of business, without regard to choice-of-law rules. Severability: If any provision is held invalid, the remaining provisions shall remain in full force.

Employee Certification

I certify, under penalty of perjury where applicable, that the statements made in this Agreement are true and complete. I understand that providing false information may result in discipline up to and including termination and potential civil or criminal liability.

Authorization to Contact Previous Employers

Employee authorizes Employer to contact previous employers and references provided herein to verify employment history, job duties, and reasons for separation. Employee understands that information obtained will be used solely for purposes related to this Agreement and employment verification.

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