Dedicated School Staffing - Direct Deposit Change Form
Direct Deposit Change Form
Organization:
Dedicated School Staffing
Assigned To:
Public User
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Please complete any section of this form that requires updating to your personnel file.
By submitting this form you certify all the above information is correct and understand that all personnel records will be updated to reflect this change.
If you have any questions, please contact our office at 419-725-9499 or email at payroll@dedicatedschoolstaffing.com
Full Name
Full Name required
Please select the account type
Checking
Savings
Please select the account type required
Bank Name
Bank Name required
Routing Number
Routing Number required
Account Number
Account Number required
Percentage of Pay into this Account: (type either "Entire Pay" or enter the percentage of pay you'd like to receive in this account)
*this percentage plus the second percentage must equal 100%
Percentage of Pay into this Account: (type either "Entire Pay" or enter the percentage of pay you'd like to receive in this account) *this percentage plus the second percentage must equal 100% required
If you've chosen a percentage of pay to go into your first account enter the second account information below.
Second Account Type
Checking
Savings
Second Account Bank Name
Second Account Routing Number
Second Account Number
Percentage of Pay into the Second Account: (this number plus the percentage in the first account must equal 100%)
Last 4 of Social Security Number
Last 4 of Social Security Number required
Signing
Signature is required
By typing in your name (your “eSignature”), you accept and consent to be legally bound by this document’s statements, terms and conditions as if this document was signed by you in writing with pen on paper. You agree that no third party or other means of verification is necessary to validate your eSignature and that the lack of such third party or other means of verification will not in any way affect the enforceability of this document.
Upload a photo of your account information (voided check or direct deposit letter)
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If you have a second account, please upload a photo of your second account information (voided check or direct deposit letter)
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History
Step:
Substitute
Sent To: Public User, On:
12/22/2024 12:34:29 PM Eastern Standard Time