Information
Employment
*
Please Select
A&R Mechanical
A&R Services
Name
*
First Name
Last Name
Hire Date
*
-
Month
-
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Date of Birth
*
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Month
-
Day
Year
Date
Social Security Number
*
Driver's License Number
*
Gender
*
Please Select
Male
Female
Non-binary
Ethnic Group
*
Veteran Status
*
Yes
No
Union Trade
*
Union Local
*
Union Class
*
OSHA 10
*
Yes
No
OSHA 30
*
Yes
No
Emergency Contact
Name
First & Last Name
Relationship
Mother, father, spouse, etc.
Phone Number
Please enter a valid phone number.
Federal Tax Withholding Information
Tax Filing Status
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Please Select
Single or Married filing separately
Married filing jointly or Qualifying surviving spouse
Head of Household
Claim Dependent and Other Credits
Complete this section if you have qualifying dependents and your total income will be $200,000 or less ($400,000 or less if married filing jointly)
Multiply the number of qualifying children under 17 by $2000
Multiply the number of other dependents by $500
Other Adjustments
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:
*
Extra withholding - Enter any additional tax you want withheld each pay period:
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Illinois Tax Withholding Information
Check all that apply:
No one else can claim me as a dependent
I can claim my spouse as a dependent
Enter the total number of basic allowances that you are claiming. Entering lower numbers here will result in more money being withheld (deducted) from your pay:
*
Check all that apply:
I am 65 or older
My spouse is 65 or older
I am legally blind
My spouse is legally blind
Enter the additional amount you want withheld (deducted) from each pay:
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Form I-9
I attest that I am:
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A citizen of the United States
A noncitizen of the United States
A lawful permanent resident
An alien authorized to work
Please upload a copy of your Driver’s License or State ID, and SS card or Birth Certificate, OR US Passport.
*
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I acknowledge that I have reviewed these documents in their entirety.
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Direct Deposit Agreement
Name of Financial Institution
*
Routing Number
*
Account Number
*
Type of Account
*
Checking
Savings
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