Employee Payroll Information Sheet
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1EMPLOYEE PAYROLL INFORMATION SHEET
DEPARTMENT
_______________________________________________
SOCIAL SECURITY NUMBER
_______________________________________________
NAME
_______________________________________________
ADDRESS
_______________________________________________
TOWN
_______________________________________________
ZIP CODE
_______________________________________________
MARITAL STATUS
_______________________________________________
NUMBER OF DEPENDENTS
_______________________________________________
SEX
_______________________________________________
DATE OF BIRTH
_______________________________________________
DATE OF EMPLOYMENT
_______________________________________________
WAGE TAX CODE NUMBER ( TOWN )
_______________________________________________
BASE RATE
_______________________________________________
EMPLOYEE TIME ( HOURLY-PER-DIEM-SALARY)
_______________________________________________
RETIREMENT RATE
_______________________________________________
EXTRA RETIREMENT DEDUCTION
_______________________________________________
UNION NAME
_______________________________________________
UNION DUES BI-WEEKLY AMOUNT
_______________________________________________
UNITED FUND
_______________________________________________
CREDIT UNION ACCOUNT NUMBER
_______________________________________________
CHRISTMAS FUND
_______________________________________________
BOND DEDUCTION
_______________________________________________
MISCELLANEOUS DEDUCTION
_______________________________________________
SICK DAYS
_______________________________________________
VACATION DAYS
_______________________________________________
STENO. CODE
_______________________________________________
NO. FICA CODE
_______________________________________________
EXTRA FEDERAL WITHOLDING TAX
_______________________________________________
EXTRA STATE TAX
_______________________________________________
NATIONAL RETIREMENT (NRP)
_______________________________________________
OCC/PRIV. TAX CODE
_______________________________________________
HOLIDAYS
_______________________________________________
JOB CLASS NAME
_______________________________________________
STRAIGHT BASE RATE
_______________________________________________
COMPENSATION CODE
_______________________________________________
_______________________________________ NEW________________________________________EMPLOYEE CHANGE
___________________________________TRANSFER _____________________________________CANCELLATION
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