Our company recognizes that employees at times will encouter emergencies or difficult circumstances where they need an advance of payment for the time they have worked before the scheduled payday.
Each employee may request payment for time already worked and receive payment prior to payday up to one time per twelve month period.
Repayment of the loan made will be automatically deducted from the next scheduled paycheck.
Employee salary advance payments must be approved by the department manager and can only be issued by payroll.
Name of Employee
I am requesting an advance payment of my salary in the amount of $ ______.
Select Repayment Terms
[__] I agree that this salary advance will be repaid in full by making a deduction from the next scheduled paycheck
[__] I agree that this salary advance will be repaid by making equal deductions from the next ____ paychecks.
I authorize, if employment ends prior to full repayment is made, that the remaining balance due will be deducted from the final paycheck.
_______________________ Date_____
Employee Signature
_______________________ Date_____
Manager Signature