Fill and Sign the Payroll Deduction Form Template 10 Free Sample Example

Advance Authorization for Pay Deduction Page 1 of 2Basic form © James R. McDade (ver 10-25-05) 209-667-2300 ADVANCE AUTHORIZATION FOR PAY DEDUCTION Note: Employers use this form to reinforce with an employee his or her need to return Company property and to obtain authorization for making deductions from an employee’s paycheck. Check with legal counsel if you do not know the wage and hour rules. (Delete this note prior to using form.)Note: You must follow state and federal law in this area. It is safest to have the employee agree (or at least re-agree) to a deduction or repayment plan at the time the debt or loss is incurred rather than having the employee sign a blanket authorization deduction in advance. But using this form in advance of a debt or loss may help the employee be more careful about not losing or breaking company equipment by reinforcing the fact that the employee will be held responsible for the debt or loss. It is unclear whether obtaining an authorization for the deduction in advance of the debt or loss will allow the employer to make the deduction. So the employer should seek legal counsel prior to instituting a deduction policy and using this form. In no event, however, may an employer ever deduct for loses caused by normal employee negligence. Such is deemed a cost of doing business in California. Employers are not allowed to make deductions that cause the paycheck to fall below minimum wage nor total more than 25% of the net pay. No deduction for a cash loan on the last paycheck may be larger than the previous installment payments, unless the employee voluntarily agrees in writing to the larger deduction at the time the last check is made. The above is true even if the employee has agreed to a larger, full-scale, immediate deduction in an advance blanket authorization. Improperly deducting wages can result in penalties! (Delete this note prior to use.) I, _________________________________, hereby authorize the Company to deduct from my paycheck, including my last paycheck if applicable, that amount which equals the following items: 1. The replacement cost of any Company tools which are lost or destroyed due to my gross negligence or which I fail to return to the Company at the end of my employment.2. The replacement cost of any uniforms issued to me which I lose or allow to be destroyed beyond normal wear and tear due to my gross negligence or which I fail to return to the Company at the end of my employment.3. The cost of replacing Company cell phones, product samples, catalogs, or equipment due to my gross negligence or my failure to return any such item(s) to the Company at the end of my employment.4. The cost of replacing keys or re-keying locks due to my gross negligence in losing keys or my failure to return keys at the end of my employment.5. Any other loss to the Company that is caused by my gross negligence, dishonesty or willful misconduct.6. The amount of any [vacation] [PTO] that I have taken in advance and which has not been earned by the time my employment ends. 7. The amount of any pay advance, which I understand is not a loan but is a payment in advance of services rendered. (Note to employer: Pay advances must be repaid by next pay period; otherwise this becomes and must be treated as a loan . Delete this note prior to using form.)8. The price of any goods or materials that I have purchased from the Company and that I have not paid for by the time my employment ends. These will be considered and treated as cash loans.9. The amount of any cash loan installment payment that I owe to the Company and which is normally due at the time the last paycheck is issued. I understand and agree that even though the Company and I may agree to make deductions over two or more paychecks for any particular item, the Company may deduct the full balance owed Advance Authorization for Pay Deduction Page 2 of 2Basic form © James R. McDade (ver 10-25-05) 209-667-2300the Company from my last paycheck. This provision, however, shall not apply to actual cash loans from the Company. If I am making payments on an actual cash loan, then only the regular payment will be made from the last paycheck if such payment is due; unless I agree in writing to a larger deduction at the time the last paycheck is issued. If I don’t pay back the loan in full at the time my last paycheck is issued, then I agree to continue making the regular payments on any cash loans after my employment ends until the loan is paid in full.I understand that the Company will not make any deductions, whether from my last paycheck or otherwise, that would cause my paycheck to fall below minimum wage. Nor will any deduction total more than 25% of my net pay.I understand that any loss to the Company, which I cause and which is not deducted from my last paycheck, will be billed to me. I agree to pay that bill within 30 days of my receiving the bill. If any legal process is initiated to collect on the bill, then the prevailing party will receive attorney’s fees and costs of suit from the non-prevailing party.___________________________________ Date: ______________________Employee's Signature