Employee Onboarding Information

Employee Onboarding Information
Date

MonthDayYear
Date
Desired Position
Date Available

MonthDayYear
Date
Employee Information
First*
Middle
Last*
DOB*
SSN*
Phone*
Address*
Apt/Unit
City*
State*
Zip*
Driver’s License/I.D.*
Exp
Work Eligibility
If you are under age 18, can you submit a work permit if hired?

YesNo
If you are not a US citizen, do you have a VISA to work in the US?

YesNo
If yes, what kind of Visa classification do you have?
Visa Registration Number
Expiration Date

MonthDayYear
Date
Has your bond or security clearance ever been denied and/or

YesNo
If yes, please explain
Do you have a criminal record?

YesNo
If yes, please explain
Have you ever been shown by credible evidence (e.g., a court order, jury conviction, a justice department’s investigation, or other reliable evidence) to have abused, neglected, or deprived a child or adult or to have subjected any person to serious injury as a result of intentional or grossly negligent misconduct?

YesNo
Having read the job description for the position for which you are applying, are you in all respects, able to adequately perform the duties as described?

YesNo
Under the American with Disabilities Act of 1991, this program is required to reasonably accommodate individuals with a disability. The reasonable accommodation requirement applies to the application process, any pre-employment testing, interviews, and actual employment, but only if the program supervisor is made aware that an accommodation is required. If you are disabled and require accommodation, you may request it at any time during the interview process. You are obligated to inform the program director of your needs if it will impact your ability to perform the job for which you are applying.

Education History

	Name & Location	Date Attended (MM/YYYY-MM/YYYY)	YES Diploma, Certificate, or Degree	NO Diploma, Certificate, or Degree
High School
College/University
Graduate
Other

Child Care Training & Experience
Have you attended/completed any childcare training courses?

YesNo
If yes, please specify training date

MonthDayYear
Date
Have you had CPR training within the past two years?

YesNo
If yes, please specify training date

MonthDayYear
Date
Have you had first aid training within the past three years?

YesNo
If yes, please specify training date

MonthDayYear
Date
Bright from the Start: Georgia Department of Early Care Learning requires annual childcare training, are you willing to participate?

YesNo
Work History
PLEASE LIST EMPLOYMENT HISTORY FOR THE PAST TEN YEARS, BEGINNING WITH YOUR MOST RECENT CURRENT OR LAST EMPLOYER. If you have been unemployed during any time within the past ten years, list how you spent your time. (e.g. student, housewife, unemployed, etc.)

Employment History

	Start Date	End Date	Employer Name & Address	Position	Reason for Leaving
Job 1
Job 2
Job 3
Job 4
Job 5
Job 6
Job 7

W-4 | Employee's Withholding Certificate
Step 1: Enter Personal Information

First Name and Middle Initial

Last Name

Social Security NumberAddress

City, State, Zip
Filing Status

Single or Married filing separatelyMarried filing jointly or Qualifying surviving spouseHead of household (Check only if you’re unmarried and pay more than half the costs of keeping up a home for yourself and a qualifying individual.)
Complete Steps 2–4 ONLY if they apply to you; otherwise, skip to Step 5. See page 2 for more information on each step, who can claim exemption from withholding, and when to use the estimator at www.irs.gov/W4App.
Step 2: Multiple Jobs or Spouse Works
Complete this step if you (1) hold more than one job at a time, or (2) are married filing jointly and your spouse also works. The correct amount of withholding depends on income earned from all of these jobs.
Do only one of the following.
(a) Use the estimator at www.irs.gov/W4App for most accurate withholding for this step (and Steps 3–4). If you or your spouse have self-employment income, use this option; or
(b) Use the Multiple Jobs Worksheet on page 3 and enter the result in Step 4(c) below; or
(c)   .........      If there are only two jobs total, you may check this box. Do the same on Form W-4 for the other job. This option is generally more accurate than (b) if pay at the lower paying job is more than half of the pay at the higher paying job. Otherwise, (b) is more accurate

Complete Steps 3–4(b) on Form W-4 for only ONE of these jobs. Leave those steps blank for the other jobs. (Your withholding will be most accurate if you complete Steps 3–4(b) on the Form W-4 for the highest paying job.)

Step 3: Claim Dependent and Other Credits
If your total income will be $200,000 or less ($400,000 or less if married filing jointly):
Multiply the number of qualifying children under age 17 by $2,000 $
Multiply the number of other dependents by $500   $
Add the amounts above for qualifying children and other dependents. You may add to this the amount of any other credits. Enter the total here:   $

Step 4 (Optional): Other Adjustments
a) 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 4(a)
(b) 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 4(b)
(c) Extra withholding. Enter any additional tax you want withheld each pay period 4(c)
Step 5: Sign Here

Clear
Direct Deposit Authorization
Important! Please read before completing and submitting.

I hereby voluntarily authorize the Company named above (hereafter “Employer”), either directly or through its payroll service provider, to deposit any amounts owed me, by initiating credit entries to my account (s) at the financial institution (s) of my choice (hereinafter “Bank”) indicated on this form. Further, I authorize Bank to accept and to credit any credit entries indicated by Employer, either directly or through its payroll service provider, to my account. To the extent permitted by law, in the event that Employer or its payroll service provider deposits funds erroneously into my account (s), I authorize Employer, either directly or through its payroll service provider, to debit my account for an amount not to exceed the original amount of the erroneous credit.

To the extent permitted by law, I understand that I have the right to refuse consent or revoke authorization of direct deposit at any time without fear of retaliation, and I have the right to receive any payment owed to me by other means. This authorization is to remain in full force and effect until Employer and Bank have received written notice from me of its termination in such time and manner as to afford Employer and Bank reasonable opportunity to act on it.
1) Deposit/Account Information
Bank Name   Bank Name
Routing #   Routing Number
Account #   Account Number
Type of Account   Checking   Savings
Amount to deposit in selected account:
$
Full Net Amount
2) Deposit/Account Information
Bank Name   Bank Name
Routing #   Routing Number
Account #   Account Number
Type of Account   Checking   Savings
Amount to deposit in selected account:
$
Full Net Amount
3) Deposit/Account Information
Bank Name   Bank Name
Routing #   Routing Number
Account #   Account Number
Type of Account   Checking   Savings
Amount to deposit in selected account:
$
Full Net Amount
4) Deposit/Account Information
Bank Name   Bank Name
Routing #   Routing Number
Account #   Account Number
Type of Account   Checking   Savings
Amount to deposit in selected account:
$
Full Net Amount
Document Submission
Driver's License -or- Government I.D.

Cancelof
Social Security (SSN)

Cancelof
Teaching Credentials

Cancelof
Voided Check for Direct Deposit

Cancelof
Should be Empty:

Employee Onboarding Information

Employee Information

Work Eligibility

Child Care Training & Experience

Work History

W-4 | Employee's Withholding Certificate

Direct Deposit Authorization

Document Submission