SIGNATURE AUTHORIZATION FORM

INSTRUCTIONS FOR COMPLETING THE SIGNATURE AUTHORIZATION FORM

  1. DEPARTMENT NAME – Assigned by Financial Services.
  1. PS DEPARTMENT ID – Five (5) digit code assigned by Financial Services.
  1. FUNCTION – Payroll function the individual is responsible for completing.
  1. PRINCIPLE – The primary person responsible for the function.
  1. 1ST ALTERNATE – The person who will perform the function and respond to inquiries and problems when the primary person is not available.
  1. 2ND ALTERNATE - The person who will perform the function and respond to inquiries and problems when the 1st alternate person is not available.
  1. 3RD ALTERNATE - The person who will perform the function and respond to inquiries and problems when the 1st and/or 2nd alternate person is not available.

IMPORTANT REMINDERS:

  1. An individual who performs any function in a pay cycle cannot perform any other function in that pay cycle, except the individual responsible for picking up checks can also reconcile and distribute paychecks.
  1. An individual who holds the role of Payroll Preparer cannot hold the role of Payroll Approver.
  1. The individual responsible for picking up paychecks can release the paychecks to another individual who is otherwise independent of the payroll process to be responsible to reconcile and distribute.

Effective Date: ______

DEPARTMENT NAME:______DEPT ID# ______

FUNCTION / PRINCIPAL / ALTERNATE / ALTERNATE / ALTERNATE
Person responsible to:
Complete
PS Time Entry / ______
Printed Name
______
Signature
Ext:______
Email:______ / ______
Printed Name
______
Signature
Ext:______
Email:______ / ______
Printed Name
______
Signature
Ext:______
Email:______ / ______
Printed Name
______
Signature
Ext:______
Email:______
Person responsible to:
Approve
PS time Entry / ______
Printed Name
______
Signature
Ext:______
Email:______ / ______
Printed Name
______
Signature
Ext:______
Email:______ / ______
Printed Name
______
Signature
Ext:______
Email:______ / ______
Printed Name
______
Signature
Ext:______
Email:______
FUNCTION / PRINCIPAL / ALTERNATE / ALTERNATE / ALTERNATE
Person responsible to:
Pick up Paychecks / ______
Printed Name
______
Signature
Ext:______
Email:______ / ______
Printed Name
______
Signature
Ext:______
Email:______ / ______
Printed Name
______
Signature
Ext:______
Email:______ / ______
Printed Name
______
Signature
Ext:______
Email:______
Person responsible to:
Reconcile Paychecks
Distribute Paychecks / ______
Printed Name
______
Signature
Ext:
Email:______ / ______
Printed Name
______
Signature
Ext:
Email:______ / ______
Printed Name
______
Signature
Ext:
Email:______ / ______
Printed Name
______
Signature
Ext:
Email:______

Important:1. An individual who performs any function in a pay cycle cannot perform any other function in that pay cycle, except the individual responsible

for picking up checks can also reconcile and distribute paychecks.

2. An individual who holds the role of Payroll Preparer cannot, hold the role of Payroll Approver.

3. The individual responsible for picking up paychecks can release the paychecks to another individual who is otherwise independent of the payroll process to be responsible to reconcile and distribute paychecks.

*Preparers and Approvers Certification: I will not have access to paychecks at any time for any reason, including checks to be voided or returned as unclaimed.

Revised 09/2006 Page1