Employee Data/change In Status Form - Payroll Specialities
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1EMPLOYEE DATA/CHANGE IN STATUS
2021 Commerce Drive, Suite 100 - Medford, OR 97504-9783 - tel (541) 772-0100 - fax (541) 770-3272
Company Name:
Employee #:
Social Security #:
Name:
Address:
City:
State:
Zip:
Date of Hire:
DOB:
Date of Last Raise
Email:
Single
Claiming Status:
# of Exemptions:
Married
Head of Household
Additional Withholdings: (fwt)
Additional Witholdings: (swt)
Gender:
Male
Employee Type:
Full time
Female
Part time
Temporary
Seasonal
Monthly Salary $:
Department:
Hourly Rate $:
Notes:
rev
0 1/22/2016
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Parent category: Business