Employee Application

Employee Application
Name*

First NameLast Name
Date of Birth*
00/00/2024
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Social Security Number*
000-00-0000
Phone Number*
Please enter a valid phone number.
W-4*

Single or Married filing separatelyMarried filing jointlyHead of Household
Emergency Contact
Name and Phone Number
Number of Qualifying Dependents Under the age of 17*
Number of other Dependents *
Do you want to be exempted from the withholding of Georgia's state taxes? (Applicable only if you wish to be exempted)
Direct Deposit Information (If applicable)
Initials *
Upload one document from List A OR one from List B and one from List C. If you have a social security card please provide a photo for employment authorization. Permanent Residents: we will need a photo of the front and back of the card.
Identification Documents *
Employment Authorization Documents *
Additional Documents (Ex. back of IDs or employment authorization)
Signature*

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Date
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