ML Decution Form - Edited

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Date:_________________

Nov 20, 2023 Employee Name:_____________________________________________________________


Yogesh Goyal

Branch: Pay Date:

I understand and accept that universal Staffing Inc. will be deducting my pay cheque/direct deposit
Nov,20,2023
dated ____________________ for the following reason;

Pay Advance Amount $___________________________________

Pay Advance Fee $___________________________________

CAS Safety Boots $___________________________________

Safety Vest $__________________________________

Safety Glasses $___________________________________

Swipe Card $___________________________________

Hard Hat $___________________________________

Work Gloves $___________________________________

Criminal Search Fee $________$25.00___________________________

Total Deductions $ $35.00

It is understood that the amount of $ __________________________ will be deducted from my pay.

Yogesh Goyal
Employee Signature: _________________________________ Universal Staffing Rep Initial: ________

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