Foundations Preschool Employee Information Sheet

Employee Information Sheet
THIS SECTION TO BE FILLED OUT BY EMPLOYEE
Client Company Name
U.S. Social Security Number (first three numbers)
U.S. Social Security Number (middle two numbers)
U.S. Social Security Number (last three numbers)
Date of Birth (MM)
Date of Birth (DD)
Date of Birth (YYYY)
Last (Family) Name
First Name
MI
Jr., Sr., II, etc.
Gender
Address
City
State
Zip
Telephone
Email Address
example@example.com
Emergency Contact (Name; Relation; Contact Info [phone/email])
The following section must be filled out and signed by a supervisor

AFTER the employee has completed the rest of this packet
Date of Hire (MM)
Date of Hire (DD)
Date of Hire (YYYY)
Start Date (MM)
Start Date (DD)
Start Date (YYYY)
Position
Position

HourlySalary
Position

FTPT
Wage or Salary per pay cycle
Worksite Location
Division
Department
Workers Comp Code
Employee Number
Date

MonthDayYear
Date
Supervisor Signature

Clear
Supervisor (Print Name)
New Hire EEO Information (Optional)
This form must be completed by the employee
Name
Date

MonthDayYear
Date
Self-identification is the preferred method of identifying the race and ethnic information necessary for the EEO-1 report. Employers are required to attempt to allow employees to use self-identification to complete the EEO-1 report. If an employee declines to self-identify, employment records or observer identification may be used.
Race/Ethnic Groups (Please check one)Race and ethnic designations as used by the Equal Employment Opportunity Commission do not denote scientific definitions of anthropological origins. Definitions of the race and ethnicity categories are as follows:

Hispanic or Latino - A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.White (Not Hispanic or Latino) - A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.Black or African American (Not Hispanic or Latino) - A person having origins in any of the black racial groups of Africa.Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino) - A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands.Asian (Not Hispanic or Latino) - A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.American Indian or Alaska Native (Not Hispanic or Latino) - A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment.Two or More Races (Not Hispanic or Latino) - All persons who identify with more than one of the above five races.
Sex (Please Check One)

MaleFemale
Job Categories (Please check one)The major job categories are listed below, including a brief description of the skills and training required for occupations in that category and examples of the job titles that fit each category.

Executive/Senior Level Officials and Managers – Individuals who plan, direct and formulate policies, set strategy and provide the overall direction of enterprises/organizations for the development and delivery of products or services, within the parameters approved by boards of directors or other governing bodies.First/Mid-Level Officials and Managers – Individuals who serve as managers, other than those who serve as Executive/Senior Level Officials and Managers, including those who oversee and direct the delivery of products, services or functions at group, regional or divisional levels of organizations.Professionals – Most jobs in this category require bachelor and graduate degrees, and/or professional certification.Technicians – Jobs in this category include activities that require applied scientific skills, usually obtained by post-secondary education of varying lengths.Sales Workers – These jobs include non-managerial activities that wholly and primarily involve direct sales.Administrative Support Workers – These jobs involve non-managerial tasks providing administrative and support assistance, primarily in office settings.Craft Workers – Most jobs in this category includes higher skilled occupations in construction (building trades craft workers and their formal apprentices) and natural resource extraction workersOperatives (formerly Operatives (Semi-skilled)) – Most jobs in this category include intermediate skilled occupations and include workers who operate machines or factory- related processing equipment.Laborers and Helpers (formerly Laborers (Unskilled)) – Jobs in this category include workers with more limited skills who require only brief training to perform tasks.Service Workers – Jobs in this category include food service, cleaning service, personal service, and protective service activities. Skill may be acquired through formal training, job- related training or direct experience.
Company Representative Name
Date

MonthDayYear
Date
Substance Abuse Policy Acknowledgment and Receipt
Please read this form carefully, sign, and return it to your supervisor.

I acknowledge and understand that National PEO, subsequently referred to as ‘the Company,’ has a Substance Abuse Policy that applies to all employees and leased employees. I understand a copy of the Substance Abuse Policy is available to me at any time through my supervisor or through National PEO. I understand that the Policy applies to me, and I agree to comply with all terms and conditions of the policy. I understand that I may be required to provide urine, blood, breath, and/or other samples for testing under the circumstances outlined in the Substance Abuse Policy. I understand that if I fail to comply with any aspect of the Policy, I will be subject to discipline, up to and including immediate termination of my employment with the Company. I understand that the Policy is not intended to and does not constitute a contract of employment between me and the Company. I also understand that my employment with the Company is “at will,” and that either I or the Company may terminate my employment with the Company at any time, and for any reason. I also understand that no supervisor or manager has any authority to make any statements or representations to me that change or conflict with the at-will status of my employment with the Company, or that change or conflict with any of the provisions of the Substance Abuse Policy. I understand that the at-will status of my employment with the Company can be modified only by an express written agreement signed by the President of the Company. I understand that the Substance Abuse Policy supersedes and revokes all previous practices, procedures, policies, and other statements of the Company, whether written or oral, that modify, supplement, or conflict with the Policy. I also understand that the Policy may be amended at any time.
Employee Signature

Clear
Date

MonthDayYear
Date
Employee Name (Printed)
Client Company Name
Child Support Questionnaire
Please read this form carefully, sign, and return it to your supervisor.

According to Arizona Revised Statute # 23-722,02 all employers are required to ask each new employee if they are subject to any child support orders or wage withholdings.
Company Name
Employee Name
Are you subject to a child support order or wage withholding?

Ye sNo
If you are subject to a child support order or to a wage withholding, you are required to provide a copy to your employer. This statute applies to any employee who is hired, rehired or is returning from an upaid leave of absence. Please return this form along with any child support orders or wage withholdings to your employer.
Employee Signature

Clear
Date

MonthDayYear
Date
Direct Deposit Enrollment Form
Please return form to National PEO, LLC upon completion

Please fully complete the form below to ensure a speedy and accurate enrollment. When the form is complete, please fax it back to your payroll specialist at (480) 945-1525. Attach a copy of a voided check in the box below – do not attach a deposit slip. The deposit slip does not contain the same banking information. If you wish to use your savings account and/or you don’t have a voided check, please contact your bank for a letter which includes your Routing/Account Number. NOTE: Direct Deposit Enrollment or changes to Direct Deposit can take up to one payroll cycle to process.
Upload Voided Check Photo

Cancelof
Employee Name
Employee SSN (first three numbers)
Employee SSN (middle two numbers)
Employee SSN (last three numbers)
Worksite Employer Name
Please enter the checking and/or savings account information and distribution amount below. If you wish to distribute to more accounts, please contact your payroll specialist at (480) 429-8098.
Checking Account
Bank Name
Routing/Transit Number
Account Number
Amount (% or $)
Savings Account
Bank Name (if different)
Account Number
Account Number
Amount (% or $)
Through your National PEO Employee Portal, you can view your check stubs and other payroll information online. You can also continue to receive paper check stubs, if you prefer. Which would you prefer?

I would prefer to only access my payroll information online, and no longer receive a paper check stub.I would prefer to continue receiving paper check stubs as well as online.
I authorize National PEO, LLC and the financial institution above to credit my account(s) for direct deposit and, if necessary, to initiate debits or adjustments for credits made in error. This authority will remain in effect until I have cancelled direct deposit in writing to National PEO. I understand that my voluntary or involuntary termination effectively cancels direct deposit and if employment is reinstated, a new form must be provided.

Direct deposits are forwarded electronically to our financial institution that processes it through the Clearinghouse of the Federal Reserve Bank. Your bank then posts the payroll to your account. It is your responsibility to verify that your bank has received the funds!
Employee Signature

Clear
Date

MonthDayYear
Date
Money Network PayCard Your Pay, Direct to You.

National PEO is proud to offer PayCards to all of our employees. The PayCard program uses time-tested systems--direct deposit and ATM’s--to allow employees easy access to their pay. Instead of cashing their paychecks at expensive check-cashing stores, employees’ funds are electronically deposited into their PayCard accounts every pay period. The PayCard lets employees access their pay at any time, letting them avoid long lines and costly check-cashing fees.

For full Bank of America Money Network PayCard details, visit http://www.nationalpeo.com/paycard.php.

Sound too good to be true? It’s not. Just fill out the enrollment information on this form and return it to your manager or National PEO payroll representative. We’ll take care of the rest.
Worksite Employer Name
Employee Name
Employee SSN (first three numbers)
Employee SSN (middle two numbers)
Employee SSN (last three numbers)
Date of Birth (MM)
Date of Birth (DD)
Date of Birth (YYYY)
Address
City
State
Zip
Telephone
Email Address
example@example.com
Deposit Options (choose one)

I wish to depositI wish to deposit my entire net pay
$ per pay period
I authorize National PEO to deposit each pay period my net wages, after deduction for required taxes and withholding, to the PayCard per my instructions above, and, if necessary, initiate adjustments for credits

Authorize
Through your National PEO Employee Portal, you can view your check stubs and other payroll information online. You can also continue to receive paper check stubs, if you prefer. Which would you prefer?

I would prefer to continue receiving paper check stubs as well as online.I would prefer to only access my payroll information online, and no longer receive a paper check stub.
Employee Signature

Clear
Date

MonthDayYear
Date
Employment Eligibility Verification Department of Homeland Security
Form I-9
U.S. Citizenship and Immigration Services

OMB No. 1615-0047 Expires 10/31/2022

START HERE: Read instructions carefully before completing this form. The instructions must be available, either in paper or electronically, during completion of this form. Employers are liable for errors in the completion of this form. ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work-authorized individuals. Employers CANNOT specify which document(s) an employee may present to establish employment authorization and identity. The refusal to hire or continue to employ an individual because the documentation presented has a future expiration date may also constitute illegal discrimination.

Section 1. Employee Information and Attestation (Employees must complete and sign Section 1 of Form I-9 no later than the first day of employment, but not before accepting a job offer
Last Name (Family Name)
Name

First Name (Given Name)Middle InitialOther Last Names Used (if any)
Address (Street Number and Name)
Apt. Number
City or Town
State
ZIP Code
Date of Birth (mm/dd/yyyy)

MonthDayYear
Date
U.S. Social Security Number (first number)
U.S. Social Security Number (second number)
U.S. Social Security Number (third number)
U.S. Social Security Number (fourth number)
U.S. Social Security Number (fifth number)
U.S. Social Security Number (sixth number)
U.S. Social Security Number (seventh number)
U.S. Social Security Number (eighth number)
U.S. Social Security Number (ninth number)
Employee's E-mail Address
example@example.com
Employee's Telephone Number
I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in connection with the completion of this form. I attest, under penalty of perjury, that I am (check one of the following boxes):

1. A citizen of the United States2. A noncitizen national of the United States (See instructions)3. A lawful permanent resident4. An alien authorized to work
(Alien Registration Number/USCIS Number)
(If applicable) An alien authorized to work until

MonthDayYear
Date
1. Alien Registration Number/USCIS Number
2. Form I-94 Admission Number
3. Foreign Passport Number
Country of Issuance
Signature of Employee
Today's Date (mm/dd/yyyy)

MonthDayYear
Date
Preparer and/or Translator Certification (check one)

I did not use a preparer or translator.A preparer(s) and/or translator(s) assisted the employee in completing Section 1.
(Fields below must be completed and signed when preparers and/or translators assist an employee in completing Section 1

I attest, under penalty of perjury, that I have assisted in the completion of Section 1 of this form and that to the best of my knowledge the information is true and correct.
Signature of Preparer or Translator

Clear
Today's Date (mm/dd/yyyy)

MonthDayYear
Date
Name

First Name (Given Name)Last Name (Family Name)
Address

Address (Street Number and Name)

Street Address Line 2

City or TownState

ZIP Code
Employment Eligibility Verification Department of Homeland Security
Section 2. Employer or Authorized Representative Review and Verification

(Employers or their authorized representative must complete and sign Section 2 within 3 business days of the employee's first day of employment. You must physically examine one document from List A OR a combination of one document from List B and one document from List C as listed on the "Lists of Acceptable Documents.")

Employee Info from Section 1
Name

First Name (Given Name)Last Name (Family Name)
M.I.
Citizenship/Immigration Status
List A:

Identity and Employment Authorization
Document Title
Issuing Authority
Document Number
Expiration Date (if any) (mm/dd/yyyy)

MonthDayYear
Date
Document Title
Issuing Authority
Document Number
Expiration Date (if any) (mm/dd/yyyy)

MonthDayYear
Date
Document Title
Issuing Authority
Document Number
Expiration Date (if any) (mm/dd/yyyy)

MonthDayYear
Date
List B

Identity
Document Title
Issuing Authority
Document Number
Expiration Date (if any) (mm/dd/yyyy)

MonthDayYear
Date
List C

Employment Authorization
Document Title
Issuing Authority
Document Number
Expiration Date (if any) (mm/dd/yyyy)

MonthDayYear
Date
Additional Information
Certification: I attest, under penalty of perjury, that (1) I have examined the document(s) presented by the above-named employee, (2) the above-listed document(s) appear to be genuine and to relate to the employee named, and (3) to the best of my knowledge the employee is authorized to work in the United States.
The employee's first day of employment (mm/dd/yyyy)
(See instructions for exemptions)
Signature of Employer or Authorized Representative
Today's Date (mm/dd/yyyy)

MonthDayYear
Date
Title of Employer or Authorized Representative
Name

Employer's Business or Organization NameLast Name of Employer or Authorized Representative
First Name of Employer or Authorized Representative
Address

Employer's Business or Organization Address (Street Number and Name)

Street Address Line 2

City or TownState

ZIP Code
Section 3. Reverification and Rehires (To be completed and signed by employer or authorized representative
A. New Name (if applicable)
B. Date of Rehire (if applicable)

MonthDayYear
Date
Name

First Name (Given Name)Middle InitialLast Name (Family Name)
Date (mm/dd/yyyy)

MonthDayYear
Date
C. If the employee's previous grant of employment authorization has expired, provide the information for the document or receipt that establishes continuing employment authorization in the space provided below.
Document Title
Document Number
Expiration Date (if any) (mm/dd/yyyy)

MonthDayYear
Date
I attest, under penalty of perjury, that to the best of my knowledge, this employee is authorized to work in the United States, and if the employee presented document(s), the document(s) I have examined appear to be genuine and to relate to the individual.

Signature of Employer or Authorized Representative
Today's Date (mm/dd/yyyy)

MonthDayYear
Date
Name of Employer or Authorized Representative
Employee’s Withholding Certificate
Department of the Treasury Internal Revenue Service

Complete Form W-4 so that your employer can withhold the correct federal income tax from your pay. Give Form W-4 to your employer. Your withholding is subject to review by the IRS.
Step 1:
(a)First name and middle initial
Last name
(b) Social security number
Address

Address

Street Address Line 2

City or town, state, and ZIP codeState / Province

Postal / Zip Code
(c)

Single or Married filing separatelyMarried filing jointly or Qualifying widow(er)Head 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, when to use the estimator at www.irs.gov/W4App, and privacy.
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); or (b)Use the Multiple Jobs Worksheet on page 3 and enter the result in Step 4(c) below for roughly accurate withholding; or 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 (c)
is accurate for jobs with similar pay; otherwise, more tax than necessary may be withheld

Check if applicable
TIP: To be accurate, submit a 2021 Form W-4 for all other jobs. If you (or your spouse) have self-employment income, including as an independent contractor, use the estimator.

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 Dependents
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 and enter the total here
Step 4 (optional): Other Adjustments
4(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(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(c) Extra withholding. Enter any additional tax you want withheld each pay period
Step 5: Sign Here
Under penalties of perjury, I declare that this certificate, to the best of my knowledge and belief, is true, correct, and complete.
Employee’s signature (This form is not valid unless you sign it)

Clear
Date

MonthDayYear
Date
For Privacy Act and Paperwork Reduction Act Notice, see page 3.
Step 2(b)—Multiple Jobs Worksheet (Keep for your records.)

If you choose the option in Step 2(b) on Form W-4, complete this worksheet (which calculates the total extra tax for all jobs) on only ONE

Form W-4. Withholding will be most accurate if you complete the worksheet and enter the result on the Form W-4 for the highest paying job. Note: If more than one job has annual wages of more than $120,000 or there are more than three jobs, see Pub. 505 for additional
tables; or, you can use the online withholding estimator at www.irs.gov/W4App.
1. Two jobs. If you have two jobs or you’re married filing jointly and you and your spouse each have one job, find the amount from the appropriate table on page 4. Using the “Higher Paying Job” row and the “Lower Paying Job” column, find the value at the intersection of the two household salaries and enter that value on line 1. Then, skip to line 3
1
2. Three jobs. If you and/or your spouse have three jobs at the same time, complete lines 2a, 2b, and 2c below. Otherwise, skip to line 3.

a. Find the amount from the appropriate table on page 4 using the annual wages from the highest paying job in the “Higher Paying Job” row and the annual wages for your next highest paying job in the “Lower Paying Job” column. Find the value at the intersection of the two household salaries and enter that value on line 2a

b. Add the annual wages of the two highest-paying jobs from line 2a together and use the total as the wages in the “Higher Paying Job” row and use the annual wages for your third job in the “Lower Paying Job” column to find the amount from the appropriate table on page 4 and enter this amount on line 2b

c. Add the amounts from lines 2a and 2b and enter the result on line 2c
2a
2b
2c
3. Enter the number of pay periods per year for the highest-paying job. For example, if that job pays weekly, enter 52; if it pays every other week, enter 26; if it pays monthly, enter 12, etc.
3
4. Divide the annual amount on line 1 or line 2c by the number of pay periods on line 3. Enter this amount here and in Step 4(c) of Form W-4 for the highest paying job (along with any other additional amount you want withheld)
4
Step 4(b)—Deductions Worksheet (Keep for your records

Enter an estimate of your 2021 itemized deductions (from Schedule A (Form 1040 may include qualifying home mortgage interest, charitable contributions, state and local taxes (up to $10,000), and medical expenses in excess of 10% of your income
1
Enter:

$25,100 if you’re married filing jointly or qualifying widow(er)

$18,800 if you’re head of household

$12,550 if you’re single or married filing separately
2
If line 1 is greater than line 2, subtract line 2 from line 1 and enter the result here. If line 2 is greater than line 1, enter “-0-”
3
Enter an estimate of your student loan interest, deductible IRA contributions, and certain other adjustments (from Part II of Schedule 1 (Form 1040)). See Pub. 505 for more information
4
Add lines 3 and 4. Enter the result here and in Step 4(b) of Form W-4
5
Privacy Act and Paperwork Reduction Act Notice. We ask for the information on this form to carry out the Internal Revenue laws of the United States. Internal Revenue Code sections 3402(f)(2) and 6109 and their regulations require you to provide this information; your employer uses it to determine your federal income tax withholding. Failure to provide a properly completed form will result in your being treated as a single person with no other entries on the form; providing fraudulent information may subject you to penalties. Routine uses of this information include giving it to the Department of Justice for civil and criminal litigation; to cities, states, the District of Columbia, and U.S. commonwealths and possessions for use in administering their tax laws; and to the Department of Health and Human Services for use in the National Directory of New Hires. We may also disclose this information to other countries under a tax treaty, to federal and state agencies to enforce federal nontax criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism.

You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the form displays a valid OMB control number. Books or records relating to a form or its instructions must be retained as long as their contents may become material in the administration of any Internal Revenue law. Generally, tax returns and return information are confidential, as required by Code section 6103.

The average time and expenses required to complete and file this form will vary depending on individual circumstances. For estimated averages, see the instructions for your income tax return.

If you have suggestions for making this form simpler, we would be happy to hear from you. See the instructions for your income tax return.
Should be Empty:

Employee Information Sheet

THIS SECTION TO BE FILLED OUT BY EMPLOYEE

New Hire EEO Information (Optional)

Substance Abuse Policy Acknowledgment and Receipt

Child Support Questionnaire

Direct Deposit Enrollment Form

Checking Account

Savings Account

Employment Eligibility Verification Department of Homeland Security

Form I-9

Employment Eligibility Verification Department of Homeland Security

Employee’s Withholding Certificate

Step 1:

Step 2: Multiple Jobs or Spouse Works

Step 3: Claim Dependents

Step 4 (optional): Other Adjustments

Step 5: Sign Here