PMLA Update Employment Forms

Employer Name
Welcome Aboard!
Dear Faculty Member,

Thank you for being a part of the Pico Mesivta, Professional Team!

Your work is very valuable to us and the Pico Mesivta Human Resources Department is here to support your efforts.

Below is a summary of available forms. Please select the forms you would like to update from the question below.

Thank you in advance for your cooperation!

Summary of Available Forms
- Contact Information - Address
- W4 Form - Federal
- Parsonage Form - Allowance Application for Clergy Staff (optional)
- Direct Deposit Form
If you have any questions or need any assistance filling out these forms, please feel free to contact us at hr@picomesivta.org or at 310-341-0186 x 3.

Sincerely,

Pico Mesivta - HR Department
Legal Name

First NameMiddle NameLast Name
Email
example@example.com
School Year of Employment*
select the appropriate school year
I would like to update:

Contact InformationW4 FormParsonage FormDirect Deposit Form
Contact Information

Employee & Emergency Contact Information
Employee Information
Employee Name*

First Name and Middle InitialLast Name
Home Address*

(Street Number and Name)

Apt #

City or TownState

ZIP Code
Employment Information
If available, please upload a copy of your signed Employment Letter

Browse Files

Cancelof
Employment Status*

I am a new employeeI am a returning employee, updating my required forms
FORM W-4

Department of the Treasury Internal Revenue Service - Employee’s Withholding Certificate
Complete Form W-4 so that your employer can withhold the correct federal income tax from your pay. Your withholding is subject to review by the IRS.
Step 1: Personal Information
Please note that the way you write your name and address on this form, is the way your name and address will appear on your payroll checks and W2 forms.
Legal Name*

First Name and Middle InitialLast Name
U.S. Social Security Number*
Home Address*

(Street Number and Name)

Apt #

City or TownState

ZIP Code
Filing Status*

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)Exempt
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

Use the estimator at www.irs.gov/W4App for most accurate withholding for this step (and Steps 3 - 4)Use the Multiple Jobs Worksheet below and enter the result in Step 4(c) below for roughly accurate withholdingIf there are only two jobs total, you may check this box. Do the same on Form W-4 of the other job. This option is accurate for jobs with similar pay; otherwise, more tax than necessary may be withheld
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
Will you be claiming any dependents?*

YesNo
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)
Would you like to include any other adjustments? Such as other deductions, additional withholdings, etc.*

YesNo
(a) Other income not from jobs($):
If you want tax withheld for other income you expect this year that won't have withholding, enter the amount of other income here. This may include interest, dividends, and retirement income.
(b) Deductions($):
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.
Employee's Signature*

Clear
Date*

MonthDayYear
Date
Parsonage Designation

Worksheet
Important Information - Please Read Before Completing this Form
- Compensation received as parsonage allowance is not reportable for income tax on your 1040 but is subject to self employment tax and must be reported on Schedule SE of your 1040 return. Please discuss with your accountant.
- The aggregate parsonage allowance may not exceed the fair rental market value of the home including furnishings (and garage) plus utilities. Excess amounts should be reported as income on your tax return.
- Evidence of expenses should be kept in your files.
- The Board will need review and approve this request prior to any parsonage payments being issued. You will receive a formal copy of the approval, please keep a copy for your records.
Housing Expense Summary
Set forth are the estimated expenditures anticipated during the {schoolYear268} school year, to maintain my home.
Rent/Mortgage Payments
principal & Interest
Real Estate Taxes
Renter's/Homeowners Insurance
Utilities
Repairs & Maintenance
Home Improvements
Furnishings, Appliances, Home Decor, Household Goods
Other Allowable Expenses
Total Parsonage Allowance Requested*
The above is an accurate estimate of my anticipated housing expenses. These estimated expenditures shall remain in effect unless modified.
Signature of Clergy*

Clear
Date*

MonthDayYear
Date
Authorization for Direct Deposit
Declaration
I authorize Name of School* to deposit my pay automatically to the account(s) indicated below and, if necessary, to adjust or reverse a deposit for any payroll entry made to my account in error. This authorization will remain in effect until I cancel it in writing and in such time as to afford Name of School* a reasonable opportunity to act on it.
Account Information
Name on Bank Account*
Bank Account Number*
Bank Routing Number*
Account Type*

CheckingSavings
Dollar Amount to be deposited in the account*
Please attach a voided check for the bank account to which funds should be deposited.

Browse Files

Cancelof
Account #2 Information(Optional)
Name on Bank Account
Bank Account Number
Bank Routing Number
Account Type

CheckingSavings
Dollar Amount to be deposited in the account
Please attach a voided check for the bank account to which funds should be deposited.

Browse Files

Cancelof
By requesting authorization for direct deposit, I understand that {employerName} is not committing itself or implying that payroll will be issued via direct deposit at this time. {employerName} will keep this authorization in my employee file in the event direct deposit becomes a possibility or is needed from time to time.
Employee Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

Welcome Aboard!

Contact Information

Employee Information

Employment Information

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

Parsonage Designation

Housing Expense Summary

Authorization for Direct Deposit

Declaration

Account Information

Account #2 Information(Optional)