Jefferson County Schools

Jefferson County Schools 110 Mordington Avenue Charles Town WV 25414 All Employees This form must be completed regardless of your pay option

20 or 24 Pay Request

Please sign and return this form to verify that you are aware of the payroll schedule.

If you are employed 261 days, your salary will be calculated on a 24 paycheck basis. The first paycheck will be July 10 and the final paycheck will be distributed on June 25.

If you are employed 200 days, you may choose either 20 or 24 pays. If you choose 20 pays, the first paycheck will be distributed on September 10th with the final check being distributed on June 25th. If you choose 24 pays, the first paycheck will be September 10th with 4 paychecks in the summer, July 10th and 25th; August 10th and the 25th being the final check. Beginning September 2006, Direct Deposit is required for all new employees. Direct Deposit forms must be on file in the payroll office by September 1.

If a paycheck is mailed but not received, replacement will not be made until one week after payday. I understand that:

 This payment request cannot be changed during the school term.  If I have failed to fill in the number of pays desired I will automatically be put on 20 pays.  I must be responsible for the correct address for items mailed while school is not in session. If any check is lost, a replacement cannot be made until one week after payday.  Changes in pay scale during the year will be handled in the manner requiring the least bookkeeping.  If I have subscribed to a tax shelter annuity program, deductions will be made for ten months (September- June). Deductions for State and Federal Tax, Social Security, and Retirement will be based on the amount paid each pay period. If I have PEIA Health and/or Optional Life Insurance, the premium will be withheld on the first payment of each month September through April. May and June will have deductions on the first and second pay to cover the July and August premiums. No PEIA Insurance premiums are deducted from July and August paychecks.  All paychecks and direct deposit statements will be mailed throughout the summer months as well as anytime school is not in session; otherwise, I will receive paychecks and statements at my job location.

I hereby request that my salary be paid in:

_____ 20 equal semi-monthly payments to be paid on regular pay dates _____ 24 equal semi-monthly payments to be paid on regular pay dates

This form must be completed regardless of your pay option*

Please return this form to Jefferson County Schools Payroll Department.

Name (Print Please) ______Signature: ______

Employee I.D. #______Location: ______

Employment Term: ______Days Position: ______