Faculty and Staff Payroll Deduction Commitment Form
Personal Information
Siena ID:
required
Title (Mr., Ms., Dr., etc.):
First Name:
required
Last Name:
required
Suffix (Jr., Sr., etc.):
Primary Email:
Business Phone Number:
Department:
required
Position:
required
Pledge Information
New/Existing Deduction:
required
Pay Period Schedule:
required
Amount per pay period:
$ required
Designated towards:
required
Length of Deduction:
required
# of Years/Pay Periods:
Comments:
Cancellation Policy
Cancellation Policy: If deduction period is indicated as indefinite, you recognize that this payroll deduction will stay in effect until such a time that you change it via formal notification to Human Resources and Development.  Click here to cancel your payroll deduction.
 
I agree
required
Confirmation
You are about to submit your payroll deduction form over our secure server.  Please check your information carefully for accuracy, and then click "Submit."
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