Employee Set-Up Form

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Employee Set-Up Form
Phone: (608) 826-1100
Taxes
1099 Subcontractor
PO Box 8023
Toll Free: 1-877-277-2926
Madison, WI 53708-8023
Fax: (888) 381-5521
Income Tax State __________
Unemployment Tax State ___________
Marital Status:
Married
Single
Married, tax as single
(circle one)
Federal Exemptions: ____________
State Exemptions: ____________
NEW EMPLOYEE
CHANGE EMPLOYEE INFO
Other Fed. Withholdings:
__________
$$$__________
%______
%_______
Flat $$$
Additional
Flat
Additional
Employee Information
Other State Withholdings:
Company Name
:________________________________________________________
__________
__________
_______
_______
Flat $$$
Additional $$$
Flat %
Additional %
Employee #:
Division #
______________________
:__________________________
Department #
Group #
:____________________
:____________________________
Deductions
Status:
New Hire
Active
Inactive
Terminated
Rehire
Payment Check
(Circle One)
Type
Amount Per Pay
Goal
Pre-Tax
Effective Date
Pay Frequency:
Weekly
Bi-weekly Semi-Monthly
Monthly
Health Ins
Y
N
(Circle One)
Dental
Y
N
Employee
401k
Name:
Y
N
___________________________________________________________________
(First)
(Middle)
(Last)
Other:
Y
N
Address 1
: _______________________________________________________________
Other:
Y
N
Address 2
: _______________________________________________________________
Other:
Y
N
City/State/Zip
:____________________________________________________________
Accruals
Phone #
Sex:
Race
EEOC
:(_____) _____ - _________
_______
: _______
:______
Type
Amount Per Pay
Goal
Effective Date
Vacation
Social Security #
: ______________ - ___________ -_______________
Hrs
Sick
Hrs
Job Title
Clock
W-2 Pension
: ______________________
#:__________
: Y or N
Holiday
Hrs
Term Date
Reason:
: _______/_______/_______
_____________________________
PTO
Hrs
DOB:
Hire Date
_______/_______/_______
: _______/_______/_______
Other:
Hrs
Other:
Compensation: _________________ per
Hour
Pay Period
(circle)
Hrs

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