• NEW EMPLOYEE FORM

    NEW EMPLOYEE FORM

    264 East Blackwell Street, Dover, NJ 07801 Payroll: 609-664-8844 / 973-442-9900
  • Hire Date (first day on site)*
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  • I-9 Employee Information

  • Date of Birth*
     / /
  • Format: 000-000-0000.
  • Gender*
  • Status*
  • Format: 000-000-0000.
  • I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in connection with the completion of this form. I attest, under penalty of perjury, that I am (check one of the following boxes)*
  • Today's Date*
     / /
  • I-9 Employee Review and Verification

  • Documents that Establish Both Identity and Employment Authorization

    *Provide one document from List A OR a combination of one document from List B and one document from List C as listed below.

    LIST A

    1. U.S. Passport or U.S. Passport Card
    2. Permanent Resident Card or Alien Registration Receipt Card (Form I-551)
    3. Foreign passport that contains a temporary I-551 stamp or temporary I-551 printed notation on a machinereadable immigrant visa
    4. Employment Authorization Document that contains a photograph (Form I-766)

    LIST B

    1. State issued Driver's license or ID Card
    2. ID card issued by federal, state or local government agency
    3. School ID card with a photograph
    4. Voter's registration card
    5. U.S. Military card or draft record
    6. Military dependent's ID card
    7. U.S. Coast Guard Merchant Mariner Card
    8. Native American tribal document

    LIST C

    1. Social Security Card
    2. Birth Certificate
    3. Native American tribal document
    4. U.S. Citizen ID Card (Form I-197)
    5. Identification Card for Use of Resident Citizen in the United States (Form I-179)
    6. Employment authorization document issued by the Department of Homeland Security
  • For verification purposes, I will provide Silverback Productions with my (select one)*
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  • W-4 Employee's Withholding Certificate 

  • Filing Status*
  • Today's Date*
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  • PAY REV-419 Employee's Withholding Certificate

  • Purpose. Complete Form REV-419 so that your employer can withhold the correct Pennsylvania personal income tax from your pay. Complete a new Form REV-419 every year or when your personal or financial situation changes. Photocopies of this form are acceptable.

    Note: Unless the state of residence changes, residents of the reciprocal states listed in the next paragraph do not need to refile this application every year.

    Who is Eligible for Non-withholding? You may be entitled to non-withholding of PA personal income tax if you incurred no liability for income tax the preceding tax year and/or you anticipate that you will incur no liability for income tax during the current tax year, according to the Special Tax Provisions of section 304 of the Tax Reform Code, the Servicemember Civil Relief Act (SCRA) or as a resident of the reciprocal state of Indiana, Maryland, New Jersey, Ohio, Virginia or West Virginia and your employer agrees to withhold the income tax from that state.

    When to Claim? File this certificate with your employer as soon as you determine you are entitled to claim non-withholding. You must file a certificate each year you are eligible (see Note above for an exception). If you are employed by more than one employer you must file a separate REV-419 with each employer.

    Responsibilities of Employee. You must revoke this certification within 10 days from the day you anticipate you will incur PA personal income tax liability for the current tax year. To discontinue or revoke this certification, submit notification in writing to your employer. Claimants who qualify for complete Tax Forgiveness under section 304 of the Tax Reform Code must file a PA-40, Pennsylvania Personal Income Tax Return, and Schedule SP to claim Tax Forgiveness even if they are eligible for non-withholding.

    Under the SCRA, as amended by the Military Spouses Residency Relief Act, you may be exempt from PA personal income tax on your wages if (i) your spouse is a member of the armed forces present in PA in compliance with military orders; (ii) you are present in PA solely to be with your spouse; and (iii) you and your spouse both maintain the same domicile (state residency) in another state. If you claim exemption under the SCRA, enter your state of domicile (legal residence) on Line D below and attach a copy of your spousal military identification card and your spouse’s current military orders to form REV-419.

    Responsibilities of Employer. If you agree not to withhold PA tax because your employee is a resident of a reciprocal state, you must withhold the other state’s tax. Retain Form REV-419 with your records. You are required to submit a copy of this certificate and accompanying attachments to the PA DEPART[1]MENT OF REVENUE, BUREAU OF INDIVIDUAL TAXES, PO BOX 280507, HARRISBURG, PA 17128-0507, when: 1. you have reason to believe this certificate is incorrect; 2. the PA taxable gross compensation of any employee who claimed either exemption from non-withholding a or b below exceeds $1,625 for any quarter; 3. the employee claims an exemption from withholding on the basis of residence in a reciprocal state (Indiana, Maryland, New Jersey, Ohio, Virginia or West Virginia) and therefore, you agree to withhold income tax of the employee’s state of residence; or 4. the employee claims an exemption from withholding under the SCRA as amended by the Military Spouses Residency Relief Act.

    Department’s Responsibility. Upon receipt of any exemption application, the department will make a determination and notify the employer if a change is required. If the department disapproves the application, the employer must immediately commence withholding at the regular rate. Once a certificate is revoked by the department, the employer must send any new application received from the employee to the department for approval before implementing the non-withholding.

  • Format: 000-000-0000.
  • C. I claim exemption from withholding because I declare I am a resident of the reciprocal state checked below:
  • Today's Date*
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  • Silverback Productions Direct Deposit Authorization

    *** PLEASE NOTE ****  

    If you do not enroll in Direct Deposit, your check may take up to 2 weeks to be received. If you prefer a Check, leave all fields BLANK and SIGN BELOW.

  • Type of Account
  •    is hereby authorized to directly deposit my pay to the account listed above. This authorization will remain in effect until I modify or cancel it in writing.

  • I have confirmed that the Bank information entered above is correct*
  • Today's Date*
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