New Hire Form Rev B printable pdf download

KEYSTONE PAYROLL FORM NH-C 2001 Rev B

NEW HIRE FORM

PLEASE PRINT CLEARLY

DATE ______________________________

NAME ______________________________________________

SSN ________________________________

ADDRESS __________________________________________________________________________________

CITY ________________________________________________

STATE ________ ZIP ________________

BIRTH DATE _________________________________________

HIRE DATE _________________________

RATE OF PAY ________________________________________

FULL/PART TIME ____________________

POSITION ____________________________________________

RACE ______________________________

DIVISION ___________________________________________

DEPARTMENT ______________________

WITHHOLDING W4: SINGLE/MARRIED _________________

NO. OF DEPENDENTS ________________

PAYROLL DEDUCTIONS: 401K _________________________

HEALTH INS_________________________

OTHER ______________________________________________

OTHER _____________________________

TAX COMPLIANCE: Has employee paid the OPT tax at another job ___________________________________

MUNICIPALITY/TOWNSHIP OF RESIDENCE ____________________________________________________

SCHOOL DISTRICT OF RESIDENCE ___________________________________________________________

CHANGE FORM

PLEASE PRINT CLEARLY

DATE ______________________________

NAME ______________________________________________

SSN ________________________________