Employee Application - English - MyTown Employment Solutions

First Name*

Middle Initial*

Last Name*

Social Security #:*

Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email:*

example@example.com

Phone:*

Date of Birth:*

Date

Emergency Contact:*

Emergency Contact #:

Please enter a valid phone number.

Shirt Size:*

Today's Date:*

Date

Signature of Individual*

Please Write Your Initials: By initialing and signing this application for employment I acknowledge and verify that I have received a copy of Cornerstone PEO’s policies, have read, fully understand, and agree if hired to abide by these policies.*

Worksite Employer:*

Account Type (select one):*

CheckingSavings

Bank Name:*

Transit/ABA Routing #:*

Account #:*

I wish to deposit (select one):*

Entire Net PayDollar Amount% of Net Pay

IF Dollar Amount Selected - Enter Here

IF % Amount Selected - Enter Here

Do you need to add a second Account?

YesNo

Account Type (select one):

CheckingSavings

Bank Name:

Transit/ABA Routing #:

Account #:

I wish to deposit (select one):

Entire Net PayDollar Amount% of Net Pay

IF Dollar Amount Selected - Enter Here

IF % Amount Selected - Enter Here

Filing Status Options*

Single or Married filing separatelyMarried filing jointly or Qualifying surviving spouseHead of household (Check only if you're unmarried and pay more than half the costs of keeping up a home for yourself and a qualifying individual.)

Complete Steps 2-4 ONLY if they apply to you; otherwise, skip to Step 5.

Step 2: Multiple Jobs or Spouse Works

Complete this step if you (1) hold more than one job at a time, or (2) are married filing jointly and your spouse also works. The correct amount of withholding depends on income earned from all of these jobs.

Do only one of the following.

(A) Use the estimator at www.irs.gov/W4App for the most accurate withholding for this step (and Steps 3-4). If you or your spouse have self-employment income, use this option; or

(B) Use the Multiple Jobs Worksheet on page 3 and enter the result in Step 4(c) below; or

(C) If there are only two jobs total, you may check the box below. Do the same on Form W-4 for the other job. This option is generally more accurate than (b) if pay at the lower paying job is more than half of the pay at the higher paying job. Otherwise, (b) is more accurate.........

(C)

Complete Steps 3-4(b) on Form W-4 for only ONE of these jobs. Leave those steps blank for the other jobs.

(Your withholding will be most accurate if you complete Steps 3-4(b) on the Form W-4 for the highest paying job)

Step 3: Claim Dependent and Other Credits

If your total income will be $200,000 or less ($400,000 or less if married filing jointly)

3(a) - Multiply the number of qualifying children under the age of 17 by $2000

3(b) - Multiply the number of other dependents by $500

3(c) - Add the amounts above for qualifying children and other dependents. You may add to this the amount of any other credits. Enter the total here

Step 4 (optional): Other Adjustments

4(a) - Other income (not from jobs): If you want tax withheld for other income you expect this year that won't have withholding, enter the amount of other income here.This may include interest, dividends, and retirement income

4(b) - Deductions: If you expect to claim deductions other than the standard deduction and want to reduce your withholding, use the Deductions Worksheet on page 3 and enter the result here

4(c) - Extra withholding: Enter any additional tax you want withheld each pay period

Check one of the following boxes to attest to your citizenship or immigration status.*

1. A citizen of the United States2. A noncitizen national of the United States (See Instructions.)3. A lawful permanent resident (Enter USCIS or A-Number.)4. An alien authorized to work until

If you check Item Number 4 (Expiration Date if any)

If you check Item Number 4, enter one of the following

USCIS A-Number

OR

Form I-94 Admission Number

OR

Foreign Passport Number and Country of Issuance

If you are NOT a MyTown recruited employee, please skip the section below and scroll to the bottom of the page to click SUBMIT.

Are you a MyTown Recruited Employee?

YesNo

This Section is to be Completed ONLY by MyTown Recruited Employees

Experience

Transportation

Own VehiclePublic TransportationOther

Previous Employment

	Date Employed	Company	Employer's Phone	Position Held	Final Pay Rate
1.
2.
3.

Construction Skilled Trade Experience

Only complete the sections you are experienced in

Mechanical

	YEARS of EXPERIENCE
ELECTRICAL - IND
ELECTRICAL - COMM
ELECTRICAL - RESID
HVAC - INSTALL DUCT
HVAC - COMM INSTALL
HVAC - SERVICE
PLUMBER - RESID
PLUMBER - COMM
PIPEFITTER - CHILLWATER
BOILERMAKER
PIPEWELDER
STRUCTURAL WELDER
PIPELAYER

Masonry

	YEARS of EXPERIENCE
BRICK
BLOCK
STONE
CONCRETE POUR
CONCRETE FINISHER
OTHER
FOREMAN
SUPERINTENDENT
PROJECT MGR
ESTIMATOR
HEAVY EQUIP OPER

Carpentry

	YEARS of EXPERIENCE
FORM
FRAME WOOD OR METAL
TRIM
WALLPAPER
METAL STUD INSTALL
DRYWALL HANGER
DRYWALL FINISHER
PAINTING RESID OR COMM

Certifications

	Yes/ No
OSHA-10
OSHA-30
JOURNEYMAN
MASTER

Light Industrial/Clerical Experience

Only complete the sections you are experienced in

Type a question

	YEARS of EXPERIENCE
HOSPITALITY
MANUFACTURING
FORKLIFT
ACCOUNTING
WAREHOUSE
CLERICAL

Tools:

Special Skills:

Background Check Consent

Signature:

Date:

Date

Please review your document before submitting.

I certify that all information I have provided is true, complete, and accurate to the best of my knowledge. I understand that any false, misleading, or omitted information may result in disqualification from consideration or, if employed, termination of employment.

MyTown Employment Solutions

HIPPA Authorization

APPLICATION FOR EMPLOYMENT

EMPLOYEE DIRECT DEPOSIT AUTHORIZATION AGREEMENT

Account 1

Account 2

W-4 Employee's Withholding Certificate

Employment Eligibility Verification Form I-9

MyTown Employment Solutions