Employee Info Form
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1Employer Name: _________________________________________
Employee Info: (Name Must Match Social Security Card)
First Name:
______________________________Middle Initial:______
Last Name:
_________________________________________
Social Sec #:
_________________________________________
Gender:
_________________________________________
Date of Birth:
_________________________________________
Hire Date:
_________________________________________
Job Title:
_________________________________________
Employee Contact Info:
Address (Line 1): _________________________________________
Address (Line 2): _________________________________________
City:
_________________________________________
State:
_________________________________________
Zip Code:
_________________________________________
Home Phone:
_________________________________________
Cell Phone:
_________________________________________
Email:
_________________________________________
Payroll Info:
Job Title: _____________________________________________________________
Earnings type:
Annual Salary: $___________________ (or) Hourly Rate: $___________________
Pay Frequency (Circle): Weekly (or)
Bi-Weekly (or) Semi-Monthly (or)
Monthly
Deductions:
Per Pay Period $ Amount
Annual Limit $ Amount
Health Insurance
Retirement
Other (specify):
Other (Specify):
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Parent category: Business