Employee Information Sheet - Checkright
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4EMPLOYEE INFORMATION SHEET
Need help? Call us at (804) 716-2369.
When complete, fax to (877) 355-7917.
Complete this form for each employee. Starred fields indicate required information.
Company Name*
General Information:
Employee ID No.*
Birthdate*
MM ______/ DD ______/ YY ______
If left blank, Checkright will assign ID
Employee Name*
Hire Date*
MM ______/ DD ______/ YY ______
Employee Address*
SSN*
City, State, Zip code*
Gender*
Female
Male
Email Address*
Department
Circle One:
New Hire
Rehire
Direct Deposit Information: Fill in below or attach completed and signed form.
Bank Name
Direct Deposit Authorization Forms, from the
Routing
Checkright website, must be kept in each
employee’s file for 3 years.
Account Number
Circle One:
Checking
Savings
Tax Information: Fill in below or attach completed and signed W-4 and state withholding forms.
Federal Withholdings (information from the W-4):
Single
Married
Do Not Withhold
# of Withholdings
State Withholdings (information from state form):
Single
Married
Do Not Withhold
# of Withholdings
W-4, VA-4 and I-9 Forms for each employee must be kept his/her employee file in your office.
:
Compensation
How will the employee be paid?
Hourly:
per hour
or
Salary:
annually
Other pay types, Check all that apply: Bonus
Commission
Vacation/Sick/PTO
Holiday
Other:
Vacation Pay:
Eligible for Vacation/Sick/PTO pay?
Yes
No
Accrued at what rate?
Beginning Balance?
Deductions:
$
or
%
Pretax (check if applicable)
401(k)
Health Insurance
Dental Insurance
Garnishments
Other
Other (2)
Revised 9/16/13
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Parent category: Business