COPY OF YOUR PICTURE ID

YOUR SOCIAL SECURITY NUMBER

A VOID CHECK FROM YOUR BANK OR DIRECT DEPOSIT LETTER FROM YOUR BANK

 IF YOU DON'T HAVE A COPY OF YOUR ID OF YOUR VOID CHECK/DIRECT DEPOSIT LETTER AT THE TIME OF FILLING OUT THE FORM, PLEASE SUBMIT IT TO SMILECENTER215@GMAIL.COM AT YOUR EARLIEST CONVENIENCE

Why do I have to complete a Form W-4?

The quick answer is: The IRS requires it. The longer answer is: Form W-4 tells your employer how much Federal income tax to withhold from your pay. The W-4 requires basic personal information, like your name, address, and social security number. The number of allowances (we’ll talk more about that later) and your filing status will determine how much income tax is withheld from your pay.

You can submit a new W-4 whenever you like. And when you have life changes (i.e. have a child or get married) or your financial situation changes (i.e. you get a pay raise), you should update it. You can use the TaxAct withholding calculator located within each product to see how changes to your W-4 will impact your take-home pay.

Why does my employer withhold so much from my paycheck?

Your employer has no discretion over how much tax is withheld from your pay. Every employer is required to withhold the amount that corresponds with the IRS withholding tables. The table is brokendown based on your pay, the pay period (i.e. weekly, bi-weekly, semi-monthly), and the information on the Form W-4 you completed.

What’s a withholding allowance?

A withholding allowance is a number that your employer uses to determine how much Federal and state income tax to withhold from your paycheck. The more allowances you claim on your Form W-4, the less income tax will be withheld from each paycheck. The number of allowances you should claim varies. It is based on a number of factors, such as marital status, job status, earned wages, filing status, and child or dependent care expenses.

Is a withholding allowance the same as a dependency exemption?

No, a tax withholding allowance is not a dependency exemption. However, they are loosely related.

Generally, the more children you have, the more allowances you should claim. A mistake some people often make is assuming they can only claim as many allowances as the number of children they have. That is not true. In fact, it may be better to claim more allowances than the number of children you have if you have multiple children. However, many other factors aside from children can affect the optimum number of allowances you should claim, including additional income, deductions, or tax credits.

How do allowances affect my paycheck?

The more allowances you claim, the less income tax is withheld from your pay. Fewer or zero allowances mean more income tax is withheld from your pay. To put it another way: More allowances equal more take-home pay and money in your pocket.

How much will one additional allowance change my take-home pay?

Using a withholding calculator is the quickest and easiest way to determine how a change in allowances will affect your take-home pay.

But before you make adjustments, don’t forget your state income tax withholding as that will be affected too. When you receive your first paycheck with the new withholding allowances, take note of how they affect your pay. If you believe it’s not the right amount or if your circumstances change, you can always submit a new Form W-4.

 Why would I want to check the “Married but withhold as Single” box?

You generally have less Federal taxes withheld when you check the “Married” box. That’s because the withholding tables assume you are married filing jointly with a non-working spouse. If your spouse has a significant income, you may need to check the “Married but withhold at higher Single rate” box to have enough taxable income withheld.

 Is it better to have more earned income withheld, just to play it safe?

Choosing to have too much tax withheld may feel safer and easier than figuring out how much you should withhold and how to complete the form. However, there’s nothing safe about letting the IRS hold your money for a year or more completely interest-free. The small investment of time to make sure your income tax withholding is correct is well worth it. At the same time, some taxpayers don’t want to risk having a tax bill at the end of the year – no matter how small. If that’s how you feel, adjust accordingly, provide your revised W-4 form to your employer, and plan for a small tax refund. You can still celebrate when you . Plus you can be happy knowing you didn’t have too much tax withheld

START HERE: Read instructions carefully before completing this form. The instructions must be available, either in paper or electronically,
during completion of this form. Employers are liable for errors in the completion of this form.
ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work-authorized individuals. Employers CANNOT specify which document(s) an
employee may present to establish employment authorization and identity. The refusal to hire or continue to employ an individual because the
documentation presented has a future expiration date may also constitute illegal discrimination

Section 1. Employee Information and Attestation

I attest, under penalty of perjury, that I have assisted in the completion of Section 1 of this form and that to the best of my knowledge the information is true and correct.

Certification: I attest, under penalty of perjury, that (1) I have examined the document(s) presented by the above-named employee, (2) the above-listed document(s) appear to be genuine and to relate to the employee named, and (3) to the best of my knowledge the employee is authorized to work in the United States.

I attest, under penalty of perjury, that to the best of my knowledge, this employee is authorized to work in the United States, and if the employee presented document(s), the document(s) I have examined appear to be genuine and to relate to the individual.

ACKNOWLEDGMENT OF RECEIPT OF SMILE CENTER EMPLOYEE MANUAL

I acknowledge that I have received and reviewed a copy of Employee Manual and understand I am expected to adhere to its policies and procedures. I also realize this Manual is to be retained by me for future reference. I know this information represents guidelines only and that COMPANY reserves the right to unilaterally modify this manual at any time. I recognize it is my responsibility to keep myself informed of those changes once they are made known. I further acknowledge I understand the Manual's contents, as I have the responsibility and been provided with the opportunity to address any questions I might have with the management of ASC. In addition, upon signing this Acknowledgment, I am affirming my commitment to maintain strict confidentiality of all proprietary COMPANY- related information to which I am privy, especially that which is referenced in the section of the Manual labeled "Confidentiality".

 I understand this manual does not create a promise of future benefits. IT DOES NOT CONSTITUTE AN EMPLOYMENT CONTRACT OR ALTER MY STATUS AS AN AT-WILL EMPLOYEE. Therefore, my employment may be terminated by me or by COMPANY,

with or without cause, prior warning, or notice.

I understand this Acknowledgment is to be retained by COMPANY.

REFUSAL FORM FOR HEPATITIS B VACCINE FOR COMPANY

I understand that due to my occupational exposure to blood or other potentially infectious materials I may be at risk of acquiring hepatitis B virus (HBV) infection. I have been given the opportunity to be vaccinated with hepatitis B vaccine, at no charge to myself. However, I decline hepatitis B vaccination at this time. I understand that by declining this vaccine I continue to be at risk of acquiring hepatitis B, a serious disease.If in the future I continue to have occupational exposure to blood or other potentially infectious materials and I want to be vaccinated with hepatitis B vaccine while being employed by COMPANY I can receive the vaccination series at no charge to me.

Additionally, I affirm that I have received the information packet regarding Hepatitis B provided by my employer along with this form.

Corporate Payroll Services cannot set up direct deposits for “credit only” accounts. These accounts do not allow debit entries, which are necessary for voiding and reissuing checks.

Corporate Payroll Services does not offer direct deposit of funds to either a foreign bank or a U.S. Financial institution where the entire amount will be forwarded to a bank account in another country. If either situation applies to you, do not complete this form.

If you only have one account, simply write 100 next to the % sign in the first row. You may choose up to 4 accounts into which your net pay is deposited. Please enter either a dollar amount or a percentage for all accounts. If you choose the Dollar method, all remaining amounts will be directed to the first account listed below. If using the Percentage method, the total of the percentages must equal 100%.

I hereby authorize Corporate Payroll Services, its agents and the bank named above to initiate credit and any necessary adjusting debit entries to my account(s) indicated above. This Authority is to remain in effect until Corporate Payroll Services and the bank have received written notice from me of its termination in such time and manner as to afford Corporate Payroll Services and the bank a reasonable opportunity to act on it