Employee Information Form

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As the payroll administrator for your new employer, Chambers CPA LLC requires certain information from you in order to process your pay.

By accurately completing this form, you will be giving us the information we need to ensure that your paycheck is calculated correctly, and that your pay will be deposited into your bank account without delay. If you have any concerns about any of this form's content, please let your employer know.
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Name of Your New Employer* This field is required.Who is your new employer?
Company Name
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Your Name* This field is required.Please type your name
First Name
Middle Name
Last Name
4
Birth Date* This field is required.Use the calendar icon to select your date of birth. (Typing it manually will prevent the form from submitting.)
Birth Date
Month
Day
Year
5
Social Security Number* This field is required.Type your Social Security Number below
xxx-xx-xxxx
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Address* This field is required.Type your address below
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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Phone Number* This field is required.Add your phone number below
Please enter a valid phone number. ex. (123) 456-7890
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Start Date* This field is required.Use the calendar icon to select the start date for your new job. (Typing it manually will prevent the form from submitting.)
Date
Month
Day
Year
9
Email* This field is required.Include your email below.
example@example.com
10
Marital Status* This field is required.Select using the drop-down list below
Single
Married
Exempt
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Do you have Dependents to claim?* This field is required.Dependents are people who you will be claiming on your tax return
YESNO
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How many Dependents do you plan to claim?Type the number of Dependents
13
Would you like additional withholdings taken out of your pay?* This field is required.If "Yes" you'll be able to specify state vs. federal withholdings
YESNO
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How much would you like withheld?Note: Enter Federal withholdings in the first line, and State withholdings in the second. Enter 0 to indicate no additional withholdings.
Additional Federal Withholdings
Additional State Withholdings
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Bank Institution Name* This field is required.What's the name of your bank?
Bank Name
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Bank Routing Number* This field is required.This information can be found on the bottom of your checkbook check, these are all of the numbers before your account number. If you can't find this information, your bank will be able to help you.
Routing Number
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Bank Account Number* This field is required.What's your account number?
Account Number
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Checking or Savings?* This field is required.Is the account number you entered a Checking or Savings account?
Checking
Savings
Account Type
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Please review the banking information you entered

Note: Incorrect banking information may lead to delays in receiving your pay, or even deposits into an account not owned by you. If any of the information is incorrect, use the "previous" button to go back and correct the information.

Bank Name: {bankInstitution}

Routing Number: {bankRouting}

Account Number: {bankAccount}

Checking or Savings: {checkingOr}
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Click "Next" when you have your documents ready for upload.You'll be able to upload images or .pdf files. You can use a scan of the document, or upload a picture of it directly from your phone. (Image Tip: Zoom in by tapping the image then tapping the magnifying glass in the upper right corner.)
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Will you be uploading ONE document from column A, or a document from both Column B and C?* This field is required.
Please Select
Please Select
Column A
Column B & C
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Upload your Column A document
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
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Upload your Column B document
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
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Upload your Column C document
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
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Signature* This field is required.By signing, you acknowledge that the submitted information is true and that we can use this information for payroll purposes. If any of the information provided is inaccurate, you may experience delays in receiving your pay or have your pay deposited into an account not owned by you.
Clear
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Lastly, some information for you!

After we verify your employment and setup your payroll account, you'll receive an email from noreply@accountantsworld.com. Follow the instructions in the email to setup your online account. This is how you'll be able to access information about your earnings, W-2's, and other important payroll info.

Click "Submit" to finish your form.
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