New Employee Set Up Form

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:   (____) _____-_________

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HUMAN RESOURCES USE ONLY

Employee # ________________Hourly rate: $______________Salary amount: $_________

  Full-time        Part-time (Number of hours _____________)

Department: _____________________Title: _______________Start Date: ____/____/____

Supervisor: _________________________________________________________________________