complete this form and return in enclosed envelope - Amazon Web ...
DUE MARCH 30th
Applicants Printed Name as it appears on social security card
COMPLETE THIS FORM AND RETURN IN ENCLOSED ENVELOPE
Signature
This form authorizes Kanakuk Kamps and Kids Across America to run a background check. We do this in order to protect the Kampers who have been placed in our care. For further information please read below.
Current Address and Apt #
Complete this form and mail back in enclospe.
City
During the application process and at any time during the tenure of my employment or volunteerism with Kanakuk Ministries, Inc. and/or Kids Across America, including their
State/Zip Code
employees, agents, officers, directors and representatives (hereinafter referred to collectively as the “Organization), I hereby authorize the Consumer Reporting Agency selected, on behalf of the “Organization” to procure a consumer report (known as an investigative consumer
Previous Address and Apt #
report in California). This report may be compiled with information from courts record repositories, departments of motor vehicles, past or present employers and educational institutions, governmental occupational licensing or
City
registration entities, business or personal reference, and any other source required to verify information that I have voluntarily supplied.
State/Zip Code
I understand that I may request a complete and accurate disclosure of the nature and scope of the background verification; to the extent such investigation includes
State and Driver’s License Number
information bearing on my character, general reputation, personal characteristics or mode of living.
Date of Birth I hereby release the ‘Organization’ and any person or entity, which provides information pursuant to this authorization, from any and all liabilities, claims, or lawsuits in regards to the information obtained from any and all of the above referenced sources used. The following is my true and complete legal name, and all information is true and correct to the best of my knowledge.
Social Security Number
DUE MARCH 30th
INSTRUCTIONS: • • • •
A new form should be completed for 2012, regardless of whether you enrolled in 2011. Please print or type all applicable information. Attach a VOIDED check (not a deposit slip) to this form for the checking account receiving the direct deposit. Submit the completed form with a VOIDED check to the following address OR in the attached return envelope. Kanakuk Staff - LaShell Stearns-Business Office -- Summer Staff 1353 Lake Shore Drive | Branson, M0 65616 KAA Staff - Amanda Hurley-Business Office -- Summer Staff PO Box 930 | Branson, MO 65615-0930
Employee Information Name (Last, First, MI) Please Print
Email Address
Daytime Phone
Social Security Number
Bank Account Information Routing Transit Number Account Number
Telephone Number Checking
Savings
Name of Financial Institution Address of Financial Institution
CHECK NUMBER
0301
YOUR NAME 123 YOUR STREET YOUR CITY, STATE, ZIP (123) 456-7890
DATE
PAY TO THE ORDER OF
$ DOLLARS
YOUR FINANCIAL INSTITUTION ANYTOWN, USA
MEMO |:1 2 3 4 5 6 7 8 9 |:
ROUTING NUMBER
987654321
0301
ACCOUNT NUMBER
CHECK NUMBER
Authorization I hereby authorize Kanakuk Kamps to initiate automatic deposits to my account at the financial institution designated above. If monies to which I am not entitled are erroneously credited to my account, I authorize Kanakuk Kamps to direct the financial institution to return said funds not to exceed the original credit made in error. The funds will be available to credit to your account on pay day. Banks maintain different polices relating to the time in which they process funds for direct deposit. Your bank’s policy will determine when your direct deposit funds will be available to you. If you change banks or bank accounts, If your bank makes a change to your account number, or if you received a notice that your bank is merging with another bank you must timely notify Kanakuk Kamps of the change and forward a voided check for the new account number or new routing number by submitting this form with the updated information. Kanakuk Kamps will not be responsible for overdraft fees or other charges you incur if you withdraw your funds before your bank processes the direct deposit file. Similarly, the company will not be responsible for overdraft fees or other charges you incur if you fail to make Kanakuk Kamps aware of changes in your direct deposit account or the status of that account.
Signature
Date
DUE MARCH 30th
Kanakuk Kamps will issue a payroll card ONLY IF YOU DO NOT HAVE A REGULAR CHECKING OR SAVINGS ACCOUNT at a financial institution. If you already have a financial institution, please complete sections 1-3 on Side 1 of this form. A payroll card is a prepaid debit card with all the payment capabilities of a traditional debit card. Please download the “PayChekPLUS Brochure” from the staff document site for frequently asked questions about payroll cards.
Employee Information Name (Last, First, MI) Please Print
Email Address
Daytime Phone
Social Security Number
Payroll Card Information I would like to register for a PaycheckPLUS! Select MasterCard Payroll Card issued by Central Bank (Hereinafter “Bank”). By checking this box, you are agreeing to the terms and conditions found in Section D on this page.
My Card Number (for office use only)
Authorization I hereby authorize Kanakuk Kamps to initiate automatic deposits to my Payroll Card account. If monies to which I am not entitled are erroneously credited to my account, I authorize Kanakuk Kamps to direct the financial institution to return said funds not to exceed the original credit made in error or as an overpayment to my Payroll Card account.
Signature
Date
PayCheckPLUS! Select MasterCard - Terms & Conditions Consent to Payroll Card Account: I hereby designate Central Bank (herein after, “Bank”) as my financial institution to accept the direct deposit of my wages from my employer into an account at Bank. I choose to receive a payroll card issued by Bank for the purpose of accessing my wages from my Payroll Card account. I acknowledge that third parties other than Bank may impose fees and charges in connection with the use of the Payroll Card; however, I understand that I may choose one of several transactions each pay period, which are outlined in the Cardholder Terms and Conditions, by which I can withdraw my entire net pay without the payment of a fee. Use of Prepaid Payroll Card: I may withdraw funds or make purchases through use of the Card issued by the Bank. The features and rules of the Card and applicable fees are described in the Cardholder Terms and Conditions. By signing this form, I acknowledge receipt of the Cardholder Terms and Conditions and agree to abide by all terms and provisions contained therein. Ownership of Funds: Funds will be electronically deposited into a deposit account on the books of the Bank, for my benefit. I may withdraw funds by using the Card. I may withdraw only the amount of my separate amount deposited pursuant to this Agreement in such deposit account. FDIC Insurance: Bank is a member of the Federal Deposit Insurance Corporation (“FDIC”): All value on the Card is shown in United States dollars. The unused value of the funds on the Card may be insured by the FDIC in accordance with FDIC rules and regulations. Recordkeeping and Customer Service: By signing this Acceptance Form, I agree that FSV Payment Systems, Inc. (“FSV”) will maintain the records related to the Card and the Card Account balance as an issuing agent of the Bank and will provide customer service for such Card.
Applicants Printed Name as it appears on social security card
COMPLETE THIS FORM AND RETURN IN ENCLOSED ENVELOPE
Signature
This form authorizes Kanakuk Kamps and Kids Across America to run a background check. We do this in order to protect the Kampers who have been placed in our care. For further information please read below.
Current Address and Apt #
Complete this form and mail back in enclospe.
City
During the application process and at any time during the tenure of my employment or volunteerism with Kanakuk Ministries, Inc. and/or Kids Across America, including their
State/Zip Code
employees, agents, officers, directors and representatives (hereinafter referred to collectively as the “Organization), I hereby authorize the Consumer Reporting Agency selected, on behalf of the “Organization” to procure a consumer report (known as an investigative consumer
Previous Address and Apt #
report in California). This report may be compiled with information from courts record repositories, departments of motor vehicles, past or present employers and educational institutions, governmental occupational licensing or
City
registration entities, business or personal reference, and any other source required to verify information that I have voluntarily supplied.
State/Zip Code
I understand that I may request a complete and accurate disclosure of the nature and scope of the background verification; to the extent such investigation includes
State and Driver’s License Number
information bearing on my character, general reputation, personal characteristics or mode of living.
Date of Birth I hereby release the ‘Organization’ and any person or entity, which provides information pursuant to this authorization, from any and all liabilities, claims, or lawsuits in regards to the information obtained from any and all of the above referenced sources used. The following is my true and complete legal name, and all information is true and correct to the best of my knowledge.
Social Security Number
DUE MARCH 30th
INSTRUCTIONS: • • • •
A new form should be completed for 2012, regardless of whether you enrolled in 2011. Please print or type all applicable information. Attach a VOIDED check (not a deposit slip) to this form for the checking account receiving the direct deposit. Submit the completed form with a VOIDED check to the following address OR in the attached return envelope. Kanakuk Staff - LaShell Stearns-Business Office -- Summer Staff 1353 Lake Shore Drive | Branson, M0 65616 KAA Staff - Amanda Hurley-Business Office -- Summer Staff PO Box 930 | Branson, MO 65615-0930
Employee Information Name (Last, First, MI) Please Print
Email Address
Daytime Phone
Social Security Number
Bank Account Information Routing Transit Number Account Number
Telephone Number Checking
Savings
Name of Financial Institution Address of Financial Institution
CHECK NUMBER
0301
YOUR NAME 123 YOUR STREET YOUR CITY, STATE, ZIP (123) 456-7890
DATE
PAY TO THE ORDER OF
$ DOLLARS
YOUR FINANCIAL INSTITUTION ANYTOWN, USA
MEMO |:1 2 3 4 5 6 7 8 9 |:
ROUTING NUMBER
987654321
0301
ACCOUNT NUMBER
CHECK NUMBER
Authorization I hereby authorize Kanakuk Kamps to initiate automatic deposits to my account at the financial institution designated above. If monies to which I am not entitled are erroneously credited to my account, I authorize Kanakuk Kamps to direct the financial institution to return said funds not to exceed the original credit made in error. The funds will be available to credit to your account on pay day. Banks maintain different polices relating to the time in which they process funds for direct deposit. Your bank’s policy will determine when your direct deposit funds will be available to you. If you change banks or bank accounts, If your bank makes a change to your account number, or if you received a notice that your bank is merging with another bank you must timely notify Kanakuk Kamps of the change and forward a voided check for the new account number or new routing number by submitting this form with the updated information. Kanakuk Kamps will not be responsible for overdraft fees or other charges you incur if you withdraw your funds before your bank processes the direct deposit file. Similarly, the company will not be responsible for overdraft fees or other charges you incur if you fail to make Kanakuk Kamps aware of changes in your direct deposit account or the status of that account.
Signature
Date
DUE MARCH 30th
Kanakuk Kamps will issue a payroll card ONLY IF YOU DO NOT HAVE A REGULAR CHECKING OR SAVINGS ACCOUNT at a financial institution. If you already have a financial institution, please complete sections 1-3 on Side 1 of this form. A payroll card is a prepaid debit card with all the payment capabilities of a traditional debit card. Please download the “PayChekPLUS Brochure” from the staff document site for frequently asked questions about payroll cards.
Employee Information Name (Last, First, MI) Please Print
Email Address
Daytime Phone
Social Security Number
Payroll Card Information I would like to register for a PaycheckPLUS! Select MasterCard Payroll Card issued by Central Bank (Hereinafter “Bank”). By checking this box, you are agreeing to the terms and conditions found in Section D on this page.
My Card Number (for office use only)
Authorization I hereby authorize Kanakuk Kamps to initiate automatic deposits to my Payroll Card account. If monies to which I am not entitled are erroneously credited to my account, I authorize Kanakuk Kamps to direct the financial institution to return said funds not to exceed the original credit made in error or as an overpayment to my Payroll Card account.
Signature
Date
PayCheckPLUS! Select MasterCard - Terms & Conditions Consent to Payroll Card Account: I hereby designate Central Bank (herein after, “Bank”) as my financial institution to accept the direct deposit of my wages from my employer into an account at Bank. I choose to receive a payroll card issued by Bank for the purpose of accessing my wages from my Payroll Card account. I acknowledge that third parties other than Bank may impose fees and charges in connection with the use of the Payroll Card; however, I understand that I may choose one of several transactions each pay period, which are outlined in the Cardholder Terms and Conditions, by which I can withdraw my entire net pay without the payment of a fee. Use of Prepaid Payroll Card: I may withdraw funds or make purchases through use of the Card issued by the Bank. The features and rules of the Card and applicable fees are described in the Cardholder Terms and Conditions. By signing this form, I acknowledge receipt of the Cardholder Terms and Conditions and agree to abide by all terms and provisions contained therein. Ownership of Funds: Funds will be electronically deposited into a deposit account on the books of the Bank, for my benefit. I may withdraw funds by using the Card. I may withdraw only the amount of my separate amount deposited pursuant to this Agreement in such deposit account. FDIC Insurance: Bank is a member of the Federal Deposit Insurance Corporation (“FDIC”): All value on the Card is shown in United States dollars. The unused value of the funds on the Card may be insured by the FDIC in accordance with FDIC rules and regulations. Recordkeeping and Customer Service: By signing this Acceptance Form, I agree that FSV Payment Systems, Inc. (“FSV”) will maintain the records related to the Card and the Card Account balance as an issuing agent of the Bank and will provide customer service for such Card.
