Payroll Onboarding Form
Employee Withholding Certificate (W4)
Name of Employer
*
First Name and Middle Initial
*
Last Name
*
Social Security Number
*
Street Address
*
City, State, and Zip
*
Type a question
*
Single or Married Filing Separately
Married Filing Jointly or Qualifying Surviving Spouse
Head of Household
Number of Qualifying Children under age 17
*
Total Child Tax Credit for Children under 17
Number of Other Dependents
*
Total Credit for Other Dependents
Total Dependent Credits
Other Income (Not from Jobs)
If you want tax withheld for other income youexpect 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 andwant to reduce your withholding, use the Deductions Worksheet on page 3 and enterthe result here
Additional Withholdings
If you wish to have extra federal withholdings from each paycheck
Signature (Under penalties of perjury, I declare that this certificate, to the best of my knowledge and belief, is true, correct, and complete)
*
Date
-
Month
-
Day
Year
Date
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Employment Eligibility Verification (I9)
Department of Homeland Security - US Citizen and Immigration Services
Date of Birth
*
-
Month
-
Day
Year
Date
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Check one of the following boxes to attest your citizenship or immigration status
*
A Citizen of the United States
Noncitizen National of the United States
A lawful permanent resident
A noncitizen authorized to work until the date entered below
Date Authorized to Work Until
-
Month
-
Day
Year
Date
If noncitizen, enter USCIS A-Number
If noncitizen, enter Form I-94 Admission Number
If noncitizen, enter Foreign Passport Number & Country of Issuance
I am aware that federal law provides for imprisonment and/or fines for false statements, or the use of false documents, in connection with the completion of this form. I attest, under penalty of perjury, that this information, including my selection of the box attesting to my citizenship or immigration status, is true and correct.
*
Today's Date
*
-
Month
-
Day
Year
Date
Upload Documents that establish identity and employment authorization
*
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Direct Deposit Information
Bank Name
Account Number
Routing
Account Type
Please Select
Checking
Savings
Check Image
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Direct Deposit Authorization Signature
Date
-
Month
-
Day
Year
Date
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