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
Male
Female
Other
Status
Active
In Active
Terminated
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
Single
Married
Federal Withholding Exemptions
Additional Federal Withholding Amount
State Withholding Filing Status
Single
Married
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
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of
Employee Signature
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