EMPLOYMENT APPLICATION

APPLICATION FOR EMPLOYMENT

AN EQUAL OPPORTUNITY EMPLOYER
First Name*
Middle Initial
Last Name*
Address*
Address 2
(Apartment #)
City*
State*
Zip Code*
Social Security Number*
Date of Birth*

MonthDayYear
Mobile/Home Phone Number*
Email*
example@example.com
Position Applied For*
Available Start Date*

MonthDayYear
Date
Have you ever applied for employment with Venue Smart LLC?*

YesNo
Are you legally eligible for employment in the United States?*

YesNo
Are you a U.S. Citizen?*

YesNo
How did you find out about this opportunity?*
Name of person who referred you*
Select Highest Grade Completed
Grade School

345678
High School

9101112
College

1234
CURRENT & PREVIOUS EMPLOYMENT

Please give accurate, complete full-time and part-time employment record. Start with your present or most recent employer Reason for Leaving Position.

	Name & Address of Employer	Start Date	End Date	Salary/Wage	Position	Reason for leaving
Employer #1
Employer #2
Employer #3
Employer #4

Have you been convicted of a crime in the past ten years, excluding misdemeanors and summary offences, which have not been annulled, expunged, or sealed by a court?*

YesNo
If yes, describe in full*
In Case of Emergency Notify:*
Relationship*
Emergency Telephone*
I authorize investigation of all statements contained in this application I understand that misrepresentation or omission of facts called for is cause for dismissal. Further, I understand and agree that my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without previous notice. I hereby grant permission to investigate any of the information included in this application and to have a civil and criminal background investigation performed. I hereby release from liability the employer and its representative for seeking, gathering, and using such information and all such information and all other persons, corporations, or organizations for furnishing such information. If employed, I will abide by the rules and policies of Venue Smart LLC and any rules and regulations that may become effective while I am employed.
Date

MonthDayYear
Date

Employee's Withholding Certificate
Federal Tax Withholding*

Single of Married Filing SeparatelyMarried filing jointly or Qualifying surviving spouseHead of HouseholdTax Exempt
Arizona State Tax Withholding*
If your total income will be $200,000 or less:

($400,000 or less if married filing jointly)
# of dependents under 17 years old?
# of dependents over 17 years old?
Dependents under 17 Calculation
Dependents over 17 Calculation
Qualifying Dependents Calculation
Optional Deductions
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.
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.
Extra withholding
Enter any additional tax you want withheld each pay period.

EMPLOYEE DIRECT DEPOSIT AUTHORIZATION
The rapid! PayCard® Mastercard® Payroll Card is issued by Green Dot Bank, Member FDIC, pursuant to a license by Mastercard International Incorporated. The use of this Card is subject to the terms and conditions.

The rapid! PayCard Visa® Payroll Card is issued by Green Dot Bank, Member FDIC, pursuant to a license from Visa U.S.A. Inc. This card can be used everywhere Visa debit cards are accepted.

Important Information for opening a Card account: To help the federal government fight the funding of terrorism and money laundering activities, the USA PATRIOT Act requires all financial institutions and their third parties to obtain, verify, and record information that identifies each person who opens a Card account. What this means for you: When you open a Card account, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver’s license or other identifying documents.

I authorize Venue Smart LLC to withhold the indicated amount(s), if available, from my pay, and deposit directly into the account(s) shown and/or I hereby authorize Venue Smart LLC to assign a rapid! PayCard and initiate credit entries and any correcting entries to my assigned rapid! PayCard account. The direct deposit(s) will be made on each payday, unless I notify Venue Smart LLC in writing of my intent to cancel. Upon Venue Smart LLC’s receipt of a request to cancel a direct deposit authorization, it shall become effective after a reasonable opportunity to act upon it.

In the event funds are deposited erroneously into my account, I authorize Venue Smart LLC to debit my account(s) not to exceed the original amount of the credit.

I understand that Venue Smart LLC reserves the right to refuse any direct deposit request. I also understand that all direct deposits are made through the Automated Clearing House (ACH), and that funds availability is subject to the terms and limitations of the ACH as well as my financial institution.

Note: If sending this form electronically, please type your initials and the last 4 digits of your social security number in the signature field. If sending or faxing a paper copy, please print out and sign your name(s) in the signature box.

Document Upload

Please upload all documents required to verify employment eligibility
Upload a picture of the front of ID*

Cancelof
Upload a picture of the back of ID*

Cancelof
Upload image of Social Security Card*

Cancelof

Certification
I certify that all answers and statements filled in on this application form are true to the best of my knowledge. I understand that, should this application contain any false or misleading information, my application may be refused.
Signature*

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APPLICATION FOR EMPLOYMENT

Select Highest Grade Completed

CURRENT & PREVIOUS EMPLOYMENT

Employee's Withholding Certificate

If your total income will be $200,000 or less:

Optional Deductions

EMPLOYEE DIRECT DEPOSIT AUTHORIZATION

Document Upload

Certification