CAREER CONNECTION, INC.
PAYROLL SELECTION FORM
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NAME (LAST, FIRST, MIDDLE INTIAL) SOCIAL SECURITY NUMBER
Direct deposit is Career Connection, Inc.’s preferred method of employee payroll distribution. It is possible to receive a live check instead of direct deposit; however it is important to understand that mailing live checks can result in delays. Career Connection, Inc. will make a best effort to ensure live checks are delivered to the work location and be distributed to the employee on pay-day, however Career Connection, Inc. cannot be held liable for any fees or penalties when live check distribution is delayed for any reason.
Please choose your method of payroll distribution:
□ Direct Deposit (Please fill out information below)
□ Live Check (Please sign at bottom)
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FINANCIAL INSTITUTION’S NAME (U.S. INSTITUTION’S ONLY)
TYPE OF ACCOUNT: (CH0OSE ONE) Amount: ____ Full or $______
□ CHECKING
□ SAVINGS
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ROUTING NUMBER ACCOUNT NUMBER
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FINANCIAL INSTITUTION’S NAME (U.S. INSTITUTION’S ONLY)
TYPE OF ACCOUNT: (CH0OSE ONE) Amount: ____ Full or $______
□ CHECKING
□ SAVINGS
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ROUTING NUMBER ACCOUNT NUMBER
I have established an account at the financial institution indicated above and authorize:
(1) Career Connection, Inc. to deposit my funds via Direct Deposit
(2) My financial institution to credit my account
(3) Career Connection, Inc. to initiate and my financial institution to make corrections to my account, for any deposits made in error.
This authorization will remain in effect until canceled in writing. Adequate notice of two (2) weeks must be given to Career Connection, Inc. if I change my account, close my account, or change my financial institution.
I will verify the account information reflected on the test voucher that will be received with my pay check prior to the first direct deposit and notify Career Connection Inc of any discrepancies. I am aware that the last digit of the routing number will not reflect on the test voucher.
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SIGNATURE DATE