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Home
Crime Prevention
- Community & Outreach Opportunities
PrideTown Housing
Pride Ignite
- Pride Ignite Learning Path
Pride Academy
Contact Us
Translate
- English
- Español

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Pride Academy West 1
5615 W 22nd Street
Indianapolis, IN 46224
317.247.1553

Pride Academy West 2
5570 Crawfordsville Road
Speedway, IN 46224

Pride Academy North
5711 N. Michigan Road
Indianapolis, IN 46228
317.672.9200

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Client

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Name *

SSN

Date of Birth

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Job Title Change
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Employee
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* If Job Title Change, Fill In Title

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Change Rate

Date Effective

Old Rate:

New Rate:

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401k Deduction:

3%
4%
5%
Stop withdrawals for 401k plan
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* If Other %, fill in the percentage

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PTO setup:

Setup Vacation time
Setup Paid Time off
Amount of Vacation

JMI Donations:

Setup Judah Donations
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Fill in Setup Judah Donations Amount

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Payroll Deduction:

College Choice 529
Uniform
EE Required Docs
Misc. or Other

If Misc. or Other, Fill in the amount

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Total to be Deducted $

and Amount Deducted per pay period $

One Time

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Reason for termination:

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