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Date of Birth:
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Must be at least 18 years old
Employed at:
Monthly Income:
ARE YOU a regular or reserve member of the Army, Navy, Marine Corps, Air Force, or Coast Guard, serving on active duty under a call or order that does not specify a period of 30 days or fewer (or a dependent of such member).
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Yes
No
How do you receive your pay:
(Select Pay Type)
Electronic Deposit into Checking account
Electronic Deposit into Savings account
Paper check from your employer (you deposit at the bank)
I do not have a checking or savings account
None of the above
How often are you paid?
(Select Pay Frequency)
Every Week
Every Other Week
Twice Per Month
Once Per Month
Which day?
Monday
Tuesday
Wednesday
Thursday
Friday
Please select and complete one option that describes your pay schedule:
I get paid
every two weeks
on the same day of the week.
I get paid on:
Monday
Tuesday
Wednesday
Thursday
Friday
My last paydate was:
(see your last paycheck for this date)
06/22/2009
06/29/2009
06/23/2009
06/30/2009
06/24/2009
07/01/2009
06/25/2009
07/02/2009
06/26/2009
07/03/2009
Example: I get paid every other Wednesday.
I am paid based on the
date
I get paid on the
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
13th
14th
15th
16th
17th
18th
19th
20th
21st
22nd
23rd
24th
25th
26th
27th
28th
29th
30th
31st
and
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
13th
14th
15th
16th
17th
18th
19th
20th
21st
22nd
23rd
24th
25th
26th
27th
28th
29th
30th
31st
Last Day
of every month
Example: I get paid on the 15th and last day of every month
or...
I am paid on the same day of the week, but
only twice per month
I get paid on the
first and third
second and fourth
Monday
Tuesday
Wednesday
Thursday
Friday
Example: I get paid on the first and third Friday of every month
I get paid on:
Monday
Tuesday
Wednesday
Thursday
Friday
My last paydate was:
(see your last paycheck for this date)
06/22/2009
06/29/2009
06/23/2009
06/30/2009
06/24/2009
07/01/2009
06/25/2009
07/02/2009
06/26/2009
07/03/2009
Please select and complete one option that describes your pay schedule:
I am paid on a specific
date
I get paid on the
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
13th
14th
15th
16th
17th
18th
19th
20th
21st
22nd
23rd
24th
25th
26th
27th
28th
29th
30th
31st
Last Day
of every month
Example: "I get paid on the 1st of every month"
or...
I am paid
on a certain day of a certain week
I get paid on the
first
second
third
fourth
last
Monday
Tuesday
Wednesday
Thursday
Friday
of every month
Example: "I get paid on the second Tuesday of every month"
or...
I am paid
after a certain date
I get paid on the first
Monday
Tuesday
Wednesday
Thursday
Friday
after the
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
13th
14th
15th
16th
17th
18th
19th
20th
21st
22nd
23rd
24th
25th
26th
27th
28th
29th
30th
31st
of the month
Example: "I get paid on the first Monday after the 15th of every month"
Yes
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