"New Employee Data Form - Payce"

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Schedule A –
ew Employee Data
Employee Information
Lastname:____________________Firstname:_______________Employee #:__________
Address:___________________________________________________________________
City:___________________
State:__________________
Zip Code:_____________
County (Local Tax Code):________________ State of Employment:_________________
Social Security umber:______________________ Date of Birth:___________________
Male / Female (
)
Start Date:_____________ Termination Date:____________
Please circle
Marital Status: Single / Married (
)
Please circle
Exemptions: Federal: ______
State:_______
Additional Withholdings:
$’s
%
Federal
State
Employee First Pay Information:
Hours this Pay Period
Department
Job Code
Pay Rate
Regular
Overtime
If employee is requesting Direct Deposit please complete Schedule D – Employee Direct
Deposit Authorization Enrollment Form located in the Additional Forms Section.
Standard Adjustments:
Reset at
Adj.
List all
Year-End
Based
adjustments
I.D. #
Frequency
Description
(Y or )
on Hrs.
Amount
available to
your
_______
__________
________________________
______
______
______
employees.
_______
__________
________________________
______
______
______
Frequency:
P – Per Pay
_______
__________
________________________
______
______
______
M –
Monthly
_______
__________
________________________
______
______
______
Schedule A –
ew Employee Data
Employee Information
Lastname:____________________Firstname:_______________Employee #:__________
Address:___________________________________________________________________
City:___________________
State:__________________
Zip Code:_____________
County (Local Tax Code):________________ State of Employment:_________________
Social Security umber:______________________ Date of Birth:___________________
Male / Female (
)
Start Date:_____________ Termination Date:____________
Please circle
Marital Status: Single / Married (
)
Please circle
Exemptions: Federal: ______
State:_______
Additional Withholdings:
$’s
%
Federal
State
Employee First Pay Information:
Hours this Pay Period
Department
Job Code
Pay Rate
Regular
Overtime
If employee is requesting Direct Deposit please complete Schedule D – Employee Direct
Deposit Authorization Enrollment Form located in the Additional Forms Section.
Standard Adjustments:
Reset at
Adj.
List all
Year-End
Based
adjustments
I.D. #
Frequency
Description
(Y or )
on Hrs.
Amount
available to
your
_______
__________
________________________
______
______
______
employees.
_______
__________
________________________
______
______
______
Frequency:
P – Per Pay
_______
__________
________________________
______
______
______
M –
Monthly
_______
__________
________________________
______
______
______