New Hire/change Reporting Form printable pdf download

NEW HIRE/CHANGE REPORTING FORM



New Hire

Change

Terminated

Company Name: ___________________________________________ Company Number _____________

EMPLOYEE INFORMATION (BOLD items indicate required information)

Social Security #: ____________________________________

Branch #: ___________________________________

Employee No.: ________________

Department #: _______________________________

Last Name: __________________________________________

Current Hire Date: ___________

F/T or P/T

First Name: _________________________________________

Original Hire Date (if returning):__________________

Middle Initial: ______________

Termination Date: ____________________________

Address: ____________________________________________

Rate of Pay: ____________________ hourly salary

Address 2: ___________________________________________

Default WC Code:__________________(REQUIRED)

City: _______________________________________________

Default Job: _________________________________

State: ____________________ Zip Code: ________________

Marital Status Federal/State (circle one):

County: _____________________________________________

Federal Exemptions: _______________

Phone: _____________________________________________

State Exemptions: _________________

Ethnicity: ____________________________________________

Local Tax to Withhold: ________________________

Date of Birth: ________________________________________

School District*: ______________________________

Gender: _____________________________________________

Benefit Accrual 2: _____________________________

E-mail Address (VMR) __________________________________

E-mail Pay Stub (VMR) Y/N? YES _____ NO _____

 W-2 Employee

 1099 Employee – If blank, employee will be set up as a W-2 employee

Additional Deductions (please list deductions as amount per pay)

 Child Support

Case # _________________________________

Amount: _______________/pay

 Garnishment

Order # _________________________________

Amount: _______________/pay

 Medical Insurance

Amount: _______________/pay

***We need a copy of ALL Court Orders***

 Dental Insurance

Amount: _______________/pay

 ______________________ Amount: _______________/pay

*You can find your school district by going to:

https://thefinder.tax.ohio.gov/streamlinesalestaxweb/default_schooldistrict.aspx

Under Lookup Tax Rate Choose - Address. Enter your home address and click Lookup (enter your School District Above)

Additional Information: _______________________________________________________________________________

__________________________________________________________________________________________________

63 Corbins Mill Drive

Dublin, Ohio

43017

(614) 923-2900

Fax: (614) 923-2368

New Hire/change Reporting Form

Related Articles

Related forms

Related Categories