Employee Set Up and Change Form
Employer Name ________________________________________ Date _________________
NEW EMPLOYEE
CHANGE TO EXISTING EMPLOYEE
(only fill in items that have changed)
Effective Date of Change ________________________________
Employee No. _______ Employee Name____________________________________________
Dept./Location ______________________________ Date of Birth
Mo / Day / Year
Employee Title/Position __________________________________________________________
Street Address ____________________________________________
City _________________________ State _______ Zip ____________
SSN _______________________________
Pay Rate ___________________________
Hire Date __________________________ Termination Date ____________________________
General Ledger Account Code or Expense Classification _________________________________
Withholding
Other Miscellaneous Deductions
Single
Description
Amount
Married
_____________________ __________
Exemptions ______
_____________________ __________
Additional $ ______
_____________________ __________
Additional % ______
_____________________ __________
401k
_____________________ __________
Roth
_____________________ __________
Simple IRA
Direct Deposit Account Type
Checking
Savings
Bank Name ___________________________________________________
Bank Routing No. ______________________________________________
Account No. __________________________________________________