Employee
Information Form
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(Payroll Specialist)
Client
Number ________ Attention _ __________ Date __________
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(Payroll Specialist) |
[ ] New Employee
[ ] Change Of Information for Current Employee
[ ] Rehire Of Old Employee Employee Number __________)
Employee Name (Last / First / Middle) _________________________________
(The Name As Shown On Their Social Security Card)
Address ____________________________________________________________
City & State __________________________ Zip Code ____________________
Social Security Number _____-______-_______ (New Employees Will Not Be Added Without One)
Employee Type [ ] W2 [ ] 1099 (Independent Contractor)
Department Number ___________________ Pay Frequency ______________
Per Pay Period Salary _____________ Annual Salary ___________________
Hourly Rate 1 ________ Marital Status (check one)
Rate 2 ________ Single Married
Rate 3 ________ Married Withholding At Single Rate
Birth Date _______________________ Hire Date ________________________
Federal Exemptions ________ Additional $$ ________ Flat $$ ________
If exempt, do you have a VISA? _______ (if yes, you must send copy to PAYCHEX!)
Should State Tax Be Withheld? [ ] Yes [ ] No
If Yes, Which State? ____________
State Exemptions ________ Additional $$ ________ Flat $$ ________
State Where Employee Works (SUI) ________________________
County Where Employee Lives (Maryland Only) ________________________
Fax to (703) 207-9549. Please Note That Paychex Does Not Require Federal W4’s Or W5’s, State Withholding Forms, I-9, Social Security Cards, Or Driver’s Licenses. For Direct Deposit, Send An Authorization Agreement And Voided Check. IF THE EMPLOYEE HAS A VISA, YOU MUST SEND IT TO PAYCHEX BEFORE PAYING THE EMPLOYEE!!!!!
Additional
Information / Adjustments
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