Employment & direct deposit form

Employee Name

First Name

Last Name

Social Security Number

Do not type spaces or dashes, only numbers

Birth Date

YYYY

Mailing Address

Where we should send materials?

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Permanent Address

If not the same as your mailing address, please indicate the mailing address for tax purposes.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email Address

Email Address(es) you would like the invoices and receipts sent.

Mobile Number

(###)

###

####

Direct Deposit Information

Please fill if choosing auto-debit of bank account 5 business days after emailed, monthly invoices (eligible for 3% discount; debit cards do not apply)

Name on Checking Acct.

Provide only if different than parent name (above)

First Name

Last Name

Bank Name

Bank Routing #

Checking Account #

Emergency Contact

First Name

Last Name

Emergency Contact's Mobile

(###)

###

####

Emergency Contact's Email

Emergency Contact's Relationship

Relationship to you

Direct Deposit Authorization & Acknowledgement

By typing my name below, I ("the Employee") authorize Scholastic Success to direct deposit my wages into the checking account provided. I also acknowledge and confirm that the information provided is mine and is accurate.

First Name

Last Name

Submit a new tutoring request

Name

First Name

Last Name

Email Address

Service(s) Requested

Standardized Test Prep

Subject Tutoring

Other

Additional Insight