Employee Personal Information Last Name: __________________________First Name:_____________________________ MI:___ Street Address: ___________________________________________________________________ City: ______________________________State: __________________ Zip Code: _______________ Gender:          Male       Female TAX WITHHOLDING INFORMATION Federal:  Filing Status____________ Exemptions: _____Additional amount? $__________ State: Filing Status ______________Exemptions: _____ Additional amount? $___________ Emergency Contact Information Name:_________________________________________________________ Relationship:____________________________________________________ Phone numbers     Home:  (____) _____-_________     Cell:      (____) _____-_________     Work:   (____) _____-_________ ======================================================= HUMAN RESOURCES USE ONLY Employee # ________________Hourly rate: $______________Salary amount: $_________   Full-time        Part-time (Number of hours _____________) Department: _____________________Title: _______________Start Date: ____/____/____ Supervisor: _________________________________________________________________________