HOUSTON - Employee Payroll Update

HOUSTON - Employee Payroll Update
Employee Name?*

First NameMiddle NameLast Name
Location(s)*

Rice VillageUpper KirbyPost OakHeightsMaximoMilton's & Lee'sLFM - Rice University
What is the reason for this update?*

Pay Rate ChangeVacation PayResigned/TerminatedAdd to PayrollSick PayPaid LeaveInjury (Work Related)Other
Employee Pay Rate changes are no longer submitted through Jotform. It is now the Managers' responsibility to make the updates in-house. For instructions on how to update Pay Rates, please click on the link below.

Instructions to Update Employee Pay Rates
How many Vacation days?*
What is this employee's new address?*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please download OR print the W-4 included in this form & have the employee complete for your records.
Did this employee complete a new Form W-4?*

YesNo
What information from the Form W-4 needs to be updated?*

Marital Status?Dependents Claim?Extra Withholding Amount?
New Marital Status?*

Single or Married filing separatelyMarried filing jointly or Qualifying widow(er)Head of Household
Number of Dependents?*
Extra Withholding Amount?*
Employee's New Name?*
Reason for Name Change?*
What is this employee's correct Birthdate?*

MonthDayYear
Reason?*

ResignedTerminated
Resignation/Termination Date?*
Document/Form Upload*

Cancelof
How many scheduled hours were missed?*
Amount Owed?
Which location(s) has this employee been previously employed?*

Rice VillageUpper KirbyPost OakHeightsMilton's/Lee'sMaximoLFM Rice University
Manager Initials*
Store location email*
xxxxx@localfoodstexas.com
Should be Empty: