Date:  Banner ID:

Last Name:   

First Name:

Address:    -
                    Street or Box/City/State/Zip
Home Phone: -      Work Phone: -

Email:
              @memphis.edu

Employment Information

Dept:

Employment: Full Time Part Time Temporary Contract Graduate Assistant

If Temporary or Contract , Date Assignment Begins:

Date Assignment Ends:

Payroll Type: Monthly Bi-Weekly Quarterly

NOTE: Faculty/staff must receive one payroll check from the University of Memphis each month, 12 months a year, in order to be eligible for payroll deduction. If you do not receive one paycheck each month you must pay by semester.

For Office Use Only

Cash Check Credit Card      Amount Paid $ _________________

Win DSX        ________________________________________       Date _________________

Power Park   ________________________________________       Date _________________