Payroll Deduction


Skilled Staff logo

 

PAYROLL DEDUCTION FORM

 

# of Items Description $ Cost Amount
# Steel Toe Boots $35.00
# Rubber Steel Toe Boots $20.00
# Leather Gloves $6.00
# Gloves $3.00
# Hard Hat $12.50
# Safety Glasses $3.00
# Safety Vest $13.00
# Safety Goggles/clips,etc. $3.50
# DOTMedcard $60.00
# Motor Vehicle Report $30.00
# Non DOT Physical $40.00
Total Deduction Amount

By signing below, I authorize the total deduction amount to be deducted from my next paycheck.

Employee Name (Printed)
Employee Signature
Date 

Leave this empty:

Signature arrow sign here


Signature Certificate
Document name: Payroll Deduction
lock iconUnique Document ID: 82480d9a1de3e5b97da113c5aa9c5b28357b1ac8
Timestamp Audit
March 29, 2026 10:07 am CDTPayroll Deduction Uploaded by Cheyenne Noland - [email protected] IP 46.110.217.61
Audit trial Qr code
This audit trail report provides a detailed record of the online activity and events recorded for this document.
https://www.skilledstaff.com/
Audit Trail Serial# 1635a08f270742127b5c54bf47345753