New-Employee Information
First Name
Last Name
Company Name
Optional
Start Date
-
Month
-
Day
Year
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Demographics
Address
Street Address
Street Address Line 2
City
Please Select
Alabama
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District of Columbia
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Texas
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State
Zip Code
Country
Phone Number
-
Area Code
Phone Number
SSN
Date of Birth
-
Month
-
Day
Year
Date Picker Icon
Email Address
Job Information
Title
Labor Class Code
Please Select
07 Sr. System Programmer
98 Sr. Anal/Programmer
A1-F Software Engi. P/B - Senior
A2-F Software Engineer - Senior
A3 President
A3-F Systems Engineer - Senior
A5-F Web S/W Developer - Intermediate
A6-F Software Engineer - Intermediate
A7-F Systems Eng. P/B - Intermediate
B1-F Program Manager - Senior
B3 Division Director
B4 Business Analyst
C1 Developer
C2-F Documentation Specialist - Intermediate
C3 Development Manager
D1 Prj./Tech Manager
D1-F D/B Analyst Programmer - SR.
D3 Implementation Specialist
D4 Jr. Implementation Specialist
D5-F Application Programmer -Intermediate
F2 Systems Architect
F2-F QA Analyst- Intermediate
F3 Business Architect
FA2 Software Engineer Sr.
G2 Quality Assurance Analyst
H1 Human Resources
H2 Systems Analyst
J2 Programmer
K2 Technical Writer
N4 Database Administrator
O2 Customer Service
O3 Office Staff
Q1 Finance
R1 Report Specialist
S2 Senior Account Executive
S3 Account Executive
S6 Account Manager
S8 Marketing Associate
U2 Network Sys Analyst
W2 Cert Powerbuilder Dev
X2 Sr. Software Engineer
X3 Jr. Software Engineer
X4 Software Engineer
Z1 Consultants
Z2 Consultants Offsite
Supervisor Name
Hours Per Week
Payroll Information
Pay Rate
Per
hr.
annum
Bank Name 1
Account Type
Please Select
Checking
Savings
Routing Number
Account Number
Percent to be Credited
Bank Name 2
Account Type
Please Select
Checking
Savings
Routing Number
Account Number
Percent to be Credited
Deductions
Taxes
Federal
Filing Status
Please Select
Single or Married filing separately
Married filing jointly
Head of Household
Dependents (Line 3)
Other Income (Line 4a)
Deductions (Line 4b)
Extra Withholding (Line 4c)
State
Filing Status
Single
Married
Married but withhold at Single rate
State Name
Locality
Number of Allowances
Please Select
Exempt
0
1
2
3
4
5
6
7
8
Additional Withholding
Insurance Premiums
Per Pay
Medical Insurance Election
EE Only
EE + SP
EE + CH
EE + Family
Opt-out
Health Premium
ER Cost of Healthcare
Dental Insurance Election
EE Only Low
EE Only High
EE + SP Low
EE + SP High
EE + CH Low
EE + Children Low
EE + Child(ren) High
EE + Family Low
EE+ Family High
Opt-out
Dental Premium
ER Cost of Dental
Vision Insurance Election
EE Only
EE + SP
EE + Child(ren)
Family
Opt-out
Vision Premium
FSA Medical
If blank, then 0
FSA Dependent Care
If blank, then 0
HSA EE Contribution
If blank, then 0
HSA ER Contribution EE Only
If blank, then 0
HSA ER Contribution EE +
If blank, then 0
HSA ER Contribution Value
If blank, then 0
Voluntary Life/AD&D EE
If blank, then 0
Voluntary Life/AD&D SP
If blank, then 0
Voluntary Life/AD&D CH
If blank, then 0
Voluntary STD
If blank, then 0
Voluntary LTD
If blank, then 0
Notes
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