Re-Hire Application

Employee’s Withholding Certificate Form W-4

Department of the Treasury Internal Revenue Service OMB No. 1545-0074 2023
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: Personal Information
Name

First Name and Middle InitialLast Name
Social security number
If your name does not match the name on social security card contact SSA
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Marital Status
Complete Steps 2–4 ONLY if they apply to you; otherwise, skip to Step 5.
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
TIP: If you have self-employment invome, see page 2.
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 $500
Total ($)
Step 4: Other Adjustments (optional)
(a) Other income not from jobs($):
If you want tax withheld for other income you expect this year that won't have withholding, enter the amount of other income here. This may inclide interest, dividends, and retirement income.
(b) Deductions($):
If you expect to claim deductions other than the standard deduction and want to reduce your withholding, use the Deductions Worksheet and enter the result here.
(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.
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Employee's Signature
This form is not valid unless you sign it
First date of employment

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
You can check out Page 2 - 4 here.

Submit Application
I, First Name Last Name , certify that I have read and to the best of my knowledge the information contained on this application is true. I agree to be bound by the terms and conditions stated herein. I understand that nothing contained in this employment application is intended to create a contract between me and this Company for either employment or any benefits, and further understand that if an employment relationship subsequently is established, I will have the right to terminate my employment at any time and the company will have a similar right. In addition, I understand that no promise, representation, or agreement contrary to the foregoing is binding on the company unless made in writing and signed by me and the President of the Company. I understand that I may be terminated in the event anything in this statement or other employment forms is incorrect. I authorize SPE Group and its insurers to investigate my license(s). I understand that information I provide regarding current and/or previous employers may be used, and those employer(s) will be contacted, for the purpose of investigating my safety performance history as required by 49 CFR 391.23(d) and (e). I understand that I have the right to: Review information provided by current/previous employers; Have errors in the information corrected by previous employers and for those previous employers to re-send the corrected information to the prospective employer; have a rebuttal statement attached to the alleged erroneous information if the previous employer(s) and I cannot agree in the accuracy of the information. I authorize my prior employers to release and forward the information requested by concerning my Alcohol and Controlled Substances Testing records within the previous 3 years from the date of this application. I understand that in compliance with 49 CFR 40.25(g) and 391.23(h) the information provided by my previous employer must be made in written form that ensures confidentiality, such as fax, E-mail or letter.

THIS CERTIFIES THAT THIS APPLICATION WAS COMPLETED BY ME AND THAT ALL ENTRIES ON IT AND INFORMATION IN IT ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.

DateSignatureFirst NameLast Name
Should be Empty:

Personal Information

Employee Direct Deposit Authorization

Policies & Acknowledgments

Employee’s Withholding Certificate Form W-4

Step 1: Personal Information

Step 2: Multiple Jobs or Spouse Works

Step 3: Claim Dependents

Step 4: Other Adjustments (optional)

Step 5: Sign Here

Submit Application