Employee Payroll 1. Employee Information Social Security Number * Employee ID Company ID Last name * First name * MI Address 1 * Address 2 Street Address Street Address City State --ALAKASAZARCACOCTDEDCFMFLGAGUHIIDILINIAKSKYLAMEMHMDMAMIMNMSMOMTNENVNHNJNMNYNCNDMPOHOKORPWPAPRRISCSDTNTXUTVTVIVAWAWVWIWY Zip City State --ALAKASAZARCACOCTDEDCFMFLGAGUHIIDILINIAKSKYLAMEMHMDMAMIMNMSMOMTNENVNHNJNMNYNCNDMPOHOKORPWPAPRRISCSDTNTXUTVTVIVAWAWVWIWY Zip Date of Birth Gender Department Current hire date Termination date JANFEBMARAPRMAYJUNJULAUGSEPOCTNOVDEC12345678910111213141516171819202122232425262728293031192019211922192319241925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000 MaleFemale Current status code Position status (for timeclock import) Salary amount Hourly rate 1 Hourly rate 2 ActiveTerminatedInactive Full TimePart Time Pay frequency Workers' comp code WeeklyBi-WeeklySemi-MonthlyMonthlyOther 2. Tax withholding status Federal marital status* Federal exemptions* SingleMarriedMarried, but withholding at Single rate Federal witholdings Amount Percentage Flat rateAdditional $% State withholdings Amount/Percentage Flat rateAdditiional $% State marital status State exemptions SingleMarriedMarried, but withholding at Single rate Number: SIT/SDI state SUI state Local tax/county 3. Recurring earnings/deductions Description Select one: Amount/Percentage Pre-taxPost-tax $% Description Select one: Amount/Percentage Pre-taxPost-tax $% 4. Time off balance Description Balance Description Balance 5. Direct deposit information Bank name Account type Amount to be deposited CheckingSavings $% Routing/transit number (must start with 0, 1, 2 or 3) Account number Δ