Fill and Sign the Sample Student Loan Repayment Program Service Agreement Form

Basic form © James R. McDade (ver 10-25-05) 209-667-2300 REPAYMENT AGREEMENT AND AUTHORIZATION FOR DEDUCTION FROM PAY FOR SPECIFIC DEBT Note: Employers use this form at the time a debt or loss is incurred to memorialize the debt owed to the Company and to obtain authorization for making deductions from an employee’s paycheck. (Delete this note prior to using form.)Note: You must follow state and federal law in this area. 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. Improperly deducting wages can result in penalties! (Delete this note prior to use.)I, _________________________________, hereby agree to repay the Company for the following marked items: The cost in the amount of $_______ for the Company [tools] [uniforms] [cell phone] [other: _______________] which were issued to me and which were lost, destroyed, or not returned to the Company.  The cost in the amount of $_______ for replacing keys or re-keying locks due to my gross negligence in losing the keys. The amount of $_________ for a loan made to me on __________, 20___.The amount of $_________ for a 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 within the same pay period as the advance; otherwise this becomes and must be treated as a loan. Delete this note prior to using form.) The amount of $_________ for goods or materials that I have purchased from the Company. The amount of $_______ for [vacation] [PTO] that I have taken in advance and which was not earned by the time my employment ended. The total amount to be repaid to the Company is $___________. I agree that this amount shall be  deducted in installments of $_________ per paycheck until paid in full. fully deducted from my next paycheck. fully deducted from my last paycheck.paid by deducting $_________ from my last paycheck, with the balance being paid in installments of $________ per month, due on the 10th of each month, until paid in full. [Option>Interest on the unpaid balance shall accrue in the amount of 10%, if the debt is not paid by ___________, 20___.]I understand and agree if I do not repay the debt and if any legal process is initiated to collect on the debt, then the prevailing party will receive attorney’s fees and costs of suit from the non-prevailing party.This agreement is entered into voluntarily and without coercion. I understand that if any employer threatens to withhold payment of my check unless I agree to a deduction, I can go to the Labor Commission to obtain my check.___________________________________ Date: ______________________ Employee's Signature