I attest, under penalty of perjury, that I am (check one of the following boxes). If SSN does not verify, we will seek proof of identity.

I authorize my employer to deposit my pay automatically to the accounts indicated above and, if necessary, to adjust or reverse a deposit for any payroll entry made in error. This authorization will remain in effect until I cancel it in writing and in such time as to afford my employer to act on it. I agree that this will act as my electronic signature.