NEW HIRE PAYROLL INFORMATION

Employer's Name

Payroll Representative

Are you Employee or Subcontractor?

Employee with Tax Deductions

Subcontractor, no taxes taken

First Name

Middle

Last Name

Soc. Sec. Number

D.O.B

Hire Date

Phone/Mobile

Filing Status

Number of Dependents

How will you be paid?

By Check

Direct Deposit

Direct Deposit Information

Name of your Bank

Routing Number

Bank Account No.

Account Type

Checking

Savings

(OPTIONAL) If a void check is available please upload

Browse for File

Certification:

I, by signing this agreement, I authorize my employer to use the information provided for the purpose of expense reimbursement and/or payroll processing.

Certification:

I, By signing this agreement, I authorize my employer to initiate credit entries to the account indicated above for the purpose of expense reimbursemente and/or payroll processing. I also authorize my employer to initiate, if necessary, debit entries and adjustments for any credit entries made in error.

Your Signature

Sign Here

NEW HIRE PAYROLL INFORMATION

Direct Deposit Information

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Contact Info

Address:

Email:

Phone:

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