Employee Set Up And Change Form

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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. __________________________________________________ 
 

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