EMPLOYEE INFORMATION SHEET
Complete this form for each employee OR provide us with reports that offer the EXACT same info.
Employee Name ____________________________________
Birth Date MM_____/DD_____/YY_____
Address
____________________________________
Hire Date
MM_____/DD_____/YY_____
City, State, Zip ____________________________________
Social Security No. _____________________
Email Address ____________________________________
Gender
Female
Male
(Only if you want your employee to have paystub access online)
Pay Frequency _______________ (list only if
If hired in the last 20 days, would you like New Hire Reporting on this
multiple pay frequencies for company)
employee? Yes
No
Direct Deposit Information (Max. of 2 Accounts)
Account #1
Direct Deposit to Checking
Attach a voided check from the employee’s checking account
Direct Deposit to Savings Routing#______________________Acct#____________________________Amount$________
Dollar amount only
No percentage
Account#2 (if applicable – both accounts must be Bank of America accounts for this option)
Direct Deposit to Checking
Attach a voided check from the employee’s checking account
Direct Deposit to Savings Routing#______________________ Acct#____________________________Amount: Remainder
Tax Information
Federal Withholding Status - Specify below or attach a W-4 form
Single Married Head of Household Do Not Withhold
# Of Allowances ______ Any Additional Withholding ______________
State Withholding Status - Specify below or attach a State withholding form
(
Please verify with your state regarding
)
separate withholding information
Single Married Head of Household Do Not Withhold
Local taxes?
Yes No
Do not withhold
# Of Allowances ______ Any Additional Withholding ______________
Specify any situations that an employee may have tax exemptions such as Minor Children, Visa employees, Clergy, etc.
________________________________________________________________________________________
Which types of pay does this employee receive?
Bonus
Salary $____________ per paycheck
Cash Tips
Non Taxable Per Diem
Hourly $____________ per hour
Paycheck Tips
S-Corp Owners Health Ins.
nd
2
hourly rate $_______ per hour
Clergy Housing (Cash)
Company HSA Contrib.(pretax)
Overtime Pay
Clergy Housing (In-Kind)
Allowance (specify)
Double Overtime
Personal Use of Company
Other Earnings (specify)
Holiday Pay
Car
Name:___________________
Reimbursement
Commission
4