New Employee Onboarding Packet

Counselman Onboarding Form
How To Complete These Forms:

Read through each document and complete the fillable sections that follow. If you are unsure about the information you need to enter, please leave that portion blank. You will have the opportunity to go over any questions during orientation.
If you are uncertain about a question, complete the rest of the form and HR will help you fill in incomplete sections.
Personal Info
First Name
Middle Name
Last Name
Number (To be filled in by Employer)
Spouse's Name
Date of Birth
Mailing Address

Street Address

Street Address Line 2

CityState

Zip Code
Home Address (If it is different than mailing address)

Street Address

Street Address Line 2

CityState

Zip Code
Cell Phone
Home Phone
Emergency Contact #1
Name
Relationship
Phone
Emergency Contact #2
Name
Relationship
Phone
Medical
List Any Medical Conditions
List Any Allergies
Today's Date:

MonthDayYear
Date
Signature
W-4 Form

Scroll down and fill in
First Name
Middle Initial
Last name
Social Security Number
Address

Street Address

Street Address Line 2

CityState

Zip Code
Single or Marrled filing separately
Multiple Jobs or Spouse Works
Number of dependent children (under age 17) X $2,000 =
Other Dependents X $500 =
Add the above two amounts here
Other income (not from jobs). If you want tax withheld for other income you expect this year that won't have withholding, enter the amount of other income here. This may include interest, dividends, and retirement income.
Deductions: If you expect to claim deductions other than the standard deduction and want to reduce your withholding, use the Deductions Worksheet on page 3 and enter the result here
Extra withholding. Enter any additional tax you want withheld each pay period
Employee's signature (This form is not valid unless you sign it.)
Date

MonthDayYear
Date
State Tax Exemption Certificate

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First Name
Last Name
Social Security Number
Address

Street Address

Street Address Line 2

CityState

Zip Code
If you claim no personal exemption for yourself and wish to withhold at the highest rate, enter zero here:
If you are single or married filing separately, a $1,500 personal exemption is allowed. Write "S" if claiming single exemption or "MS" if claiming the married filing separately exemption:
If you are claiming an exemption for both yourself and your spouse choose "M" or "H" if you are single with qualifying dependents and are claiming HEAD OF FAMILY exemption
4. Number of dependents (other than spouse) that you will provide more than one half of the support for during the year. See dependent qualification below.
5. Additional amount. if any, you want deducted each pay period
Dependents:

To qualify as your dependent, a person must receive more than one-half of his or her support from you for the year and must be related to you as follows:

- Your son or daughter (including legally adopted children), grandchildren, stepson, stepdaughter, son-in-law, or daughter-in-law

- Your father, mother, grandparent, stepfather, stepmother, father-in-law or mother-in-law

- Your uncle, aunt, nephew, or niece (but only if related by blood).
Employee's Signature
Date

MonthDayYear
Date
Employment Eligibility Verification

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First Name
Last Name (Family Name)
Middle Initial
Other Last Names Used (if any)
Address

Street Address

Street Address Line 2

CityState

Zip Code
Date of Birth

MonthDayYear
Date
SSN: XXX* - XX* - XXXX*
Employee's E mail Address
example@example.com
Employee's Telephone Number
Citizenship Status
Signature of Employee
Today's Date (mm/dd/yyyy)

MonthDayYear
Date
Employee/Worker Name
Type of Account
Routing / Transit Number
Checking/Savings Account Number
Financial Institution (Bank) Name
I wish to deposit (check one)
% of Net
Specific Dollar Amount
Type of Account 2
Routing / Transit Number 2
Checking / Savings Account Number 2
Financial Institution ("Bank") Name 2
I wish to deposit (check one) 2
% of Net
Specific Dollar Amount 2
Signature
Date

MonthDayYear
Date
Drug Test Waiver
First Name:
Last Name
Social Security Number
Signature:
Date:

MonthDayYear
Date
Active Employee Certificate of Agreement
First Name:
Last Name:
Signature:
Date:

MonthDayYear
Date
Employee Signature
Date

MonthDayYear
Date
Should be Empty:

Counselman Onboarding Form

How To Complete These Forms:

Personal Info

Emergency Contact #1

Emergency Contact #2

Medical

W-4 Form

State Tax Exemption Certificate

Employment Eligibility Verification

Drug Test Waiver

Active Employee Certificate of Agreement