New Hire - Rehire - Employee Changes

New Hire - Rehire - Employee Changes
Date*

MonthDayYear
Date
Who is your Payroll Specialist?*
Company Number (ID)*
Company Name*
Type of Maintenance*
Employee Information
Employee Number (if nothing specified, system will auto assign)
Employee Name*

First NameLast Name
Middle Initial
Employee's Social Security Number
Last 4 digits of Employee's SSN
Employee's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Work State*
Employee's Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Employee's Date of Birth*

MonthDayYear
Date
Gender
Ethnicity (if required by employer)
Employee's Date of Hire
Termination Date

MonthDayYear
Date
Position Status
Pay Frequency
Pay Info
Per pay period salary amount
Hourly Rate of Pay
Additional Hourly Rate #1
Additional Hourly Rate #2
Employee Division/Branch/Department/Team
Workers Comp Code
Override Div/Branch/Dept
Rate of Pay
Is this employee an LLC Member?*
How will this LLC Member be paid?
Does this employee have a work Visa?
Visa Type
Visa ID #
Tax Withholding Status
W2/1099
1099 FUI/SUI Taxable?
Federal Withholding (Please check all that apply)

Single or Married Filing SeparatelyMarried Filing JointlyHead of Household
Did employee check 'Step 2(c)' on W4?
Dependents Tax Credit Amount (Step 3) -Please include dollar value associated with qualifying dependents. Example: No dependents - $0.00
Please refer to the form W-4 for information in section 3.
Other Income (Step 4a)
Deductions (Step 4b)
Additional Federal (Step 4c)
Please indicate dollar amount or percentage
State Withholding State
SDI State
SUI State
State Withholding
Number of Dependents (if applicable)
Extra withholding per pay period
Please indicate dollar amount or percentage
Additional SWT
Override State Withholding (Specify State)
For Vermont Employees: Employee Health Care Insurance Coverage Status
SOC: The following states require the use of the 6 digit Standard Occupational Classification (SOC) code.
- Alaska
- Louisiana
- South Carolina
- Washington
- West Virginia
U.S. Bureau of Labor Statistics website: List of SOC Occupations
If this employee is working in one of the above states, please provide the SOC code:
Local Taxes (if applicable) - Please be aware: NY, VT, PA, CT, MA and several other states commonly have local taxes that need to be set up. If you believe this employee needs local taxes set up, or if you are unsure, please contact your CSR.
Employee Portal Manager Approver(s)
If this employee will be submitting changes to their employee demographic updates, direct deposit accounts, and/or time off requests in the Employee Portal, please note the individual that will be approving these requests. Primary Approver is needed, but a Secondary Approver is only needed if you wish to have a backup approver.
Employee Demographics and Direct Deposit - Primary Approver
Employee Demographics and Direct Deposit - Secondary Approver
Time Off Requests - Primary Approver
Time Off Requests - Secondary Approver

Scheduled Earnings/Deductions - The following per pay period earnings/deductions will be effective immediately. These are in addition to standard deductions.

	Deduction Name / Code	Per Pay Amount	Per Pay Percentage	Notes
1
2

Time Off Accrual - If Asure is tracking your time off accrual plan(s) in Asure Payroll/Asure HR, please list the plan(s) the employee should have added to their employee record. (example: Vacation, Sick, etc.)

	Time Off Banks (Plan Description)	Begin Balances	Notes
1
2
3
4

Additional Notes
Do you have direct deposit to set up or change?*
*Please be aware due to increased fraud activity Asure now requires a direct deposit authorization form as well as supporting documentation such as a voided check or bank letter.
Please submit the following documentation for your employee's direct deposit (this can be submitted at a separate time to not delay employees being added timely.)

Please note: we are unable to set up the direct deposit for your employee without receiving both supporting documents.

1. Direct Deposit Authorization Form

2. Valid supporting documentation validating the employee's name, bank routing, and account number:
1. Copy of voided check (cannot be a starter check or counter check)
2. Bank specification form
3. Bank letter on bank's letterhead signed by a bank representative (e-signature is not allowed)
4. Bank account statement dated within the last 30 days.
5. Pay card form printed from the vendor's site AND a copy of state or federally issued identification (driver's license, passport, ID card.)
Submitted By:*
Email Address*
example@example.com
Signature*
Should be Empty:

New Hire - Rehire - Employee Changes

Employee Information

Tax Withholding Status

Employee Portal Manager Approver(s)