POWELL COUNTY FISCAL COURT

POWELL COUNTY FISCAL COURT
NEW HIRE INFORMATION
PRINT FULL NAME
SEX

MALEFEMALE
PHONE NUMBER
ETHNICITY:

ASIANAFRICAN AMERICANWHITEHISPANICAMERICAN INDIANOTHER
JOB TITLE
START DATE

MonthDayYear
Date
STARTING SALARY PAY RATE
EMPLOYMENT TYPE

FULL TIMEPART TIMETEMPORARY
DIRECT DEPOSIT REQUEST FORM
Employee Name
Address
City
State
Zip Code
Please have my check automatically deposited into the following account:
Bank Name
Bank Routing Number
Checking Account Number
OR
Savings Account Number
I authorize POWELL COUNTY FISCAL COURT and my bank to automatically deposit my paycheck into my account listed above (this includes my authorization to correct entries made in error). This authorization will remain in effect until I give written notice to cancel.
Employee Signature
Date

MonthDayYear
Date
I, First Name Last Name ,understand that upon starting my employment for Powell County Fiscal Court I will have a six month probationary period. During this probationary period I realize I will not be subject to the benefits associated with full time employment and will not be until I have completed this period of time. The mentioned benefits include but are not limited to such things as: uniforms, insurance, sick time and vacation time. None of these things will become available or start to accumulate until I have passed the six month period. Vacation time can't accrue until a full year of work has been completed..
SignatureDate
Printed Name
Should be Empty:

OR