New Employee Hire Form

Company/ Employer Name*
Employee Name ( As listed on Soc. Sec. Card)*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Employee's E-mail address
(To provide employee access to paystubs and W2 online)
Social Security #*
Birth Date*

MonthDayYear
Hire Date*

MonthDayYear

Withholding as documented on Form W4
Step 1 (c) Marital Status*
Step 2 (c) Multiple Jobs- Is this box checked*

YesNo
Step 3 Dependents Credit Adjustment, if any
Employee needs to take the # of dependent(s) and multiply by $500 or $2,000 and add those total up for an answer. (Leave blank if blank of Form W4)
Step 4 (a) Other income (not from Job), if any
Step 4 (b) Deductions (deductions wksht), if any
Step 4 (c) Extra Withholding (per check), if any
Withholding for State taxes, if applicable
Marital Status*
# of allowance*
Pay Information
Amount*
Pay Type*
Deductions
Is this employee subject to wage or child support garnishments?*
If yes, send us copies of all garnishment orders
Please describe any other deductions

Direct deposits

Complete this section if employer offers direct deposit
Name of employees bank
Bank Routing # (9 digits)
Bank account number
Signature

Clear
Make sure all information is entered in correct before submitting. Once you hit the submit button you no longer will be able to make change. If changes needs to be made then call our office (801)576-9998. Thanks
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