ࡱ> KOJ bjbjn1n1 2 [g [gdTTgT]]]$q ;"] TT3!666T866660U\f4^670g6 4 6 6]Z@64+]]]  p]]]g ]]]]]]]]]X : JACKSONVILLE UNIVERSITY PAYROLL CHECK REQUEST: Date Requested_________________ Pay out on next Student Pay Day SS/STUDENT NUMBER______________________________________ PAY TO: _______________________________________GROSS AMOUNT_________________________ ADDRESS______________________________________________PHONE___________________________ ARE BENEFITS TO BE DEDUCTED: YES NO LEAVE TYPE USED: VACATION _____________HRS SICK________HRS PERSONAL ____________HRS OTHER______HRS OTHER HOURS EXPLANANTION______________________________________ POSITION ID_____________________________________________PAY TYPE____________________ ACCOUNT NUMBER ______________________________________FUND SOURCE_______________ REASON FOR REQUEST: Attachments to be mailed with check Yes: No: . Student Pay is mailed to address on file, if no Direct Deposit on file REQUESTED BY______________________________________________________________ SUPERVISOR APPROVED BY__________________________________________________ Circle SVP : Kristie Gover Christine Sapienza Scott Bacon Alex Ricker-Gilbert Randy Freebourn Teresa MacGregor Return to: Special Instructions: DO NOT WRITE BELOW THIS LINE Date received in Payroll:________________________________ Received by:__________________________________________ Date check processed __________________________________ Processed by:_________________________________________ Check number________________________________________ *ALL REQUESTED INFORMATION MUST BE COMPLETED, TO ENSURE PROPER AND TIMELY PROCESSING. JACKSONVILLE UNIVERSITY IS AN EQUAL OPPORTUNITY EMPLOYER. 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