Form W-4 - Employee'S Withholding Allowance Certificate - 2017 Page 11

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WORK LOCATION REQUIRED

City

County

UNION COMMERCIAL PAYROLL TIME CARD

State

Foreign

PLEASE COMPLETE W-4 REVERSE SIDE

WEEKENDING DATE

PREP

SHADED AREAS ARE FOR ACCOUNTING USE ONLY

ADDRESS CHANGE

SHOOT

PRODUCTION COMPANY

UNION

OCCUPATION

EMPLOYEE NAME

SOCIAL SECURITY NO.

E-MAIL ADDRESS

WRAP

HIRE DATE

LOANOUT CO.

FED. I.D.

TOTAL GROSS

KIT RENTAL

AICP ACCT. #

MILEAGE

AICP ACCT. #

PER DIEM ALLOWANCE

PER DIEM TAXABLE

AICP ACCT. #

MEAL ALLOWANCE

AICP ACCT. #

JOB

LOCATION

TIME

1ST MEAL

TIME

AICP # HOURLY

MEAL

FORCED CHECK ONE

DATE

STR

1.5

COMMENTS

NAME/NO.

ZIP CODE

2ND MEAL

OUT

RATE

PEN

CALLS

SUN

MON

TUE

WED

THU

FRI

SAT

Affordable Care Act Employment Basis:

MUST CHECK ONE

TOTALS

Full Time

Part Time

Variable Hour

Seasonal

Yes Date: _______________ COMMENTS

Employment Ended:

CA personnel: We have a Medical Provider Network (MPN) for all work-related injuries and/or illnesses. In the event of an injury, your care will be directed to a physician

Special Unpaid Leave:

From ___________ To ___________

within the MPN. You may qualify to pre-designate a doctor. For more information, please contact us at 310 440 9675 or .

y signing, you certify that the record of time worked is correct.

______________________________________________________________

____________________________________________________

___________________________________________________________________

EMPLOYEE SIGNATURE

EMPLOYEE PHONE NUMBER

PRODUCTION COMPANY APPROVAL