"Employee Profile Form - Time and Payroll"

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EMPLOYEE PROFILE
COMPANY NAME:
New Hire
Active Employee Change
Rehire
EMPLOYEE INFORMATION:
Name as on SS card: ______________________________________________________________________
Hire Date: ________________________________ Date of Birth: __________________________________
Social Security #:___________________________ Employee Time Card #: _________________________
Position: _________________________________ Department: __________________________________
Status:
Full-Time
or
Part-Time
or
Seasonal
Gender:
Male
or
Female
Address: ________________________________________________________________________________
City: ____________________________________ State: ________________________ Zip: ___________
Phone: __________________________________ Email Address: ________________________________
PAY INFORMATION:
Pay Rate: ________________________________
Pay Type: Hourly or Salaried Exempt or Salaried Non-Exempt or Commission or Piecework
TAX INFORMATION:
Tax
Filing Status
Number of
Extra Dollar
Withholdings
(circle one)
Exemptions
Amount to Withhold
FEDERAL
Single / Married / Head of Household
STATE
Single / Married / Head of Household
SPECIAL INSTRUCTIONS:
02.16.16
EMPLOYEE PROFILE
COMPANY NAME:
New Hire
Active Employee Change
Rehire
EMPLOYEE INFORMATION:
Name as on SS card: ______________________________________________________________________
Hire Date: ________________________________ Date of Birth: __________________________________
Social Security #:___________________________ Employee Time Card #: _________________________
Position: _________________________________ Department: __________________________________
Status:
Full-Time
or
Part-Time
or
Seasonal
Gender:
Male
or
Female
Address: ________________________________________________________________________________
City: ____________________________________ State: ________________________ Zip: ___________
Phone: __________________________________ Email Address: ________________________________
PAY INFORMATION:
Pay Rate: ________________________________
Pay Type: Hourly or Salaried Exempt or Salaried Non-Exempt or Commission or Piecework
TAX INFORMATION:
Tax
Filing Status
Number of
Extra Dollar
Withholdings
(circle one)
Exemptions
Amount to Withhold
FEDERAL
Single / Married / Head of Household
STATE
Single / Married / Head of Household
SPECIAL INSTRUCTIONS:
02.16.16