NON-CLERGY EMPLOYEE ENROLLMENT FORM

1
Church Name* This field is required.
2
Employee Status* This field is required.
New Hire
Current Employee
Rehired
Former Employee (For Historical Data)
3
Employee's Name* This field is required.
First Name
Last Name
4
SSN* This field is required.
5
Additional Personal Information* This field is required.Please fill out the dates in the following format: MM/DD/YYYY
Date of Birth
Hire Date
6
Address* This field is required.
Address
City
Please Select
Please Select
AL
AK
AZ
AR
CA
CO
CT
DC
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
State
Zip Code
Please Select
Please Select
On-Site
Remote (WFH)
Work Location
7
Employee's E-mail AddressE-mail account for employee's online paystub access
example@example.com
8
Payroll Schedule
Monthly (12 payroll/year)
Semi-Monthly(24 payroll/year)
Bi-Weekly (26 payroll/year)
Weekly (52 payroll/year)
9
Compensation Type* This field is required.Select all that apply. "Other" can include (but are not limited to) line items like: auto allowance, professional allowance, cell allowance, health stipend.
Salary - Exempt
Salary - Non-Exempt
Hourly
Other
10
Salary Pay Rate TypeSelect the format that you'll be entering. If you select annual amount that figure will be divided by the number of pay periods and paid out each payday.
Amount per payroll
Annual Amount
11
Salary* This field is required.A salary is a method of payment, not an exemption from the Fair Labor Standards Act (FLSA). Unless the position independently qualifies for an FLSA exemption (executive, administrative, or professional duties — or the ministerial exception), the employee is non-exempt. Non-exempt employees must receive at least the applicable minimum wage for all hours worked and overtime at 1.5× their regular rate for any hours over 40 in a workweek, even when they're paid a fixed salary. For that reason, the church should track actual hours worked internally for this employee. A simple timesheet or time-clock record is enough. Those records: Confirm the salary, divided by hours actually worked, never falls below minimum wage Establish the regular hourly rate used to calculate any overtime owed Satisfy FLSA recordkeeping requirements (payroll records 3 years; time records 2 years) Tracking hours does not change how the employee is paid, the salary stays the same. It simply documents compliance and protects the church if hours ever exceed 40 in a workweek. State wage-and-hour rules may set higher standards, so those should be checked as well.
12
Does This Employee Need Online Time Tracking Setup?
YESNO
13
Time Tracking Method
Time Punch
Time Sheet
14
Hourly Rate* This field is required.
15
Describe Other Compensation
Huge
Large
Normal
Small
Ok
Ok
16
When was the last time this employee updated their W4 form?
Prior to 12/31/2019
After 1/1/2020
17
W-4 (Pre-2020)* This field is required.
Single
Please Select
Single
Married
Married (withhold at single rate)
Exempt
Status
Number of Allowances
Additional Federal Withholding Per Pay Period
18
W-4 (Current)* This field is required.If the employee would like a flat dollar amount withheld instead of using the tax tables. Select Status: Exempt & the dollar amount in "Extra Withholding - Field 4c"
Filing Status
Filing Status
Single/Married Filing Separate
Married Filing Jointly/Qualifying Widow
Head of Household
Exempt
Status
Unchecked
Please Select
Unchecked
Checked
Box 2C
$0
Please Select
$0
$500
$1000
$1500
$2000
$2200
$2500
$2700
$3200
$3700
$4200
$4400
$4700
$4900
$5400
$5900
$6400
$6600
$6900
$7100
$7600
$8100
$8600
$8800
$9100
$9300
$9800
$10300
$10800
$11000
Dependents claimed (in dollars) - Field 3
Other Income - Field 4A
Deductions - Field 4B
Extra Withholding - Field 4c
19
State WithholdingIf the employee would like a flat dollar amount withheld instead of using the tax tables. Select Status: Exempt & the dollar amount in "Additional State Withhold Per Pay Period"
Please Select
Please Select
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
State (if different than the employee's address)
Please Select
Please Select
Single
Married
Married (withhold at Single rate)
Exempt
Other (Mention in Comments)
Status
Allowances
Additional State Withholding Per Pay Period
Comments
20
MA | Compliance NotationFor set-up compliance purposes, click next to continue.
21
WA | Subject to Other Taxes?If none of these apply, leave them blank and click next.
Please Select
Please Select
Exempt
Non-Exempt
State Paid Family Medical Leave (PFML)
Please Select
Please Select
Exempt
Non-Exempt
State Long-Term Care
22
Form 8274 ExemptionFor notation purposes only. please click next.
23
PA Withholding Status
Exempt
Regular
24
Local Taxes (if applicable) If no local taxes apply, just click next.
Name of Township, County, School District, etc...
Name of Township, County, School District, etc...
Name of Township, County, School District, etc...
Name of Township, County, School District, etc...
25
AZ Income Tax Withholding Rate
0.8%
0.5%
1.0%
1.5%
2.0%
2.5%
3.0%
3.5%
26
Employee Deductions and Employer Contributions
27
Additional Comments/Questions
Huge
Large
Normal
Small
Ok
Ok
28
Submitted By:* This field is required.
Name
Please enter your email
29
* This field is required.Data Verification
30
Signature* This field is required.
Should be Empty: