Employee Payroll Data

Employee Payroll Data
Employee ID
SSN
Name

First Name Middle Name Last Name
Address1
Address 2
City
State
Zip
Birth date

Month Day Year
Date
Gender
Status
Full Time Part Time
Pay Rate
Other Amount
Hire Date

Month Day Year
Date
Re-Hire Date

Month Day Year
Date
Termination Date(if Applocable)

Month Day Year
Date
Department:

Office Field Staff
Termination Reason (if applicable)
Federal Withholding Filing Status
Federal Withholding Exemptions
Additional Federal Withholding Amount
State Withholding Filing Status
State Withholding Exemptions
Additional State Withholding Amount
Work Tax Location (SUI State)
Direct Deposit Type
ABA/Routing Number
Account Number
Deposit Amount
Please Atteched

Voided Cheque (for Checking Account) Saving Deposit Slip(For Saving Account)
Pls. Attached

Browse Files

Cancel of
Employee Signature

Clear
Should be Empty: