2015 Summer Worker Agreement

Please fill in the following information.
Paper copies of this form are available in the Student Employment Office in CTC 307.
* First Name
Middle Initial
* Last Name
* ID Number: * Phone Number:
* Employing Department(s)
I am registered for the following number of credit hours:
* Summer quarter
* Fall quarter
Carefully read each statement below and indicate that you understand and agree.
* I have already paid my back bill and summer rent.
* I have already signed up for a voluntary payroll deduction.
* My current payroll deduction is
Please change my voluntary deduction for the summer to
* For the summer only, I agree to have the following percentage of my gross earnings deducted from my paycheck:
(If I do not want to have this deduction, I understand I may see a financial counselor to make other payment arrangements)
* I will pay Walla Walla University EACH MONTH for any charges not covered by a payroll deduction.
* If I do not pay my bill on time, a FINANCE CHARGE of one percent (1%) per month will be charged. This is an ANNUAL PERCENTAGE RATE of twelve percent (12%).
* I need to save the balance of my summer earnings for the coming school year.
* I realize if I don’t have savings from my summer earnings for the school year, it may affect my enrollment.
* I will take personal responsibility for honoring this agreement.
* Walla Walla University’s use of your electronic signature requires your consent. You have the right to have this document provided to you in paper form at no charge. You also have the right to withdraw your consent, to use your electronic signature, by contacting a University representative. Consequences for withdrawing your consent, if any, will be discussed with you when the withdrawal request is received.

By typing in your name and clicking on the "Submit" button below, you are providing electronic consent to use your electronic signature and agree that all information you are providing to Walla Walla University on this document is true, complete and correct to the best of your knowledge.    
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