EMPLOYEE INFORMATION SHEET
Complete this form for each employee.
General Information
Employee Name
_____________________________
Birth Date
MM____/DD____/YY____
Address
______________________________
Hire Date
MM____/DD____/YY____
City, State, Zip
______________________________
Social Security No. __________________
Email Address
______________________________
Gender
Female
Male
Direct Deposit Information
Will this employee be paid by direct deposit?
Direct deposit
Yes
No
If yes, attach completed Authorization of Direct Deposit form
Tax Information
Please attach or specify the following information for this employee:
Attach completed federal Form W-4
Attach completed state withholding form
Only applicable if state income tax and filing status/allowances are different from federal
Specify any payroll taxes that this employee is exempt from, such as state unemployment, social security, or
Medicare:
_________________________________________________________________________________________
Specify any local taxes that need to be withheld from this employee’s paycheck: ______________________
Notes:
Pay Information
How often will this employee be paid?
Pay Frequency
Payday details
Every Week
Date(s) or day(s) employees paid
_______________________
st
th
Every Other Week
(e.g. 1
and 15
of the month)
Twice a Month
Every Month
Period Covered
_______________________
st
Other________
(e.g. Paycheck on the 1
covers the
th
16
to the end of the prior month)