Company Number: Employee Number: Social Security Number: First Name: Middle Name: Last Name: Address: City: State: Postal Code: Country: Home Phone: Work Phone: Title: Phone Extension: Birthdate: Date Hired: Date Terminated: Federal Exemptions: State Exemptions: County Exemptions: School Exemptions: Joint Filing (Married): State - Joint Filing (Married): 1099 Employee: Fed Tax Exempt: FICA/Med Exempt: State Tax Exempt: County Tax Exempt: School Tax Exempt: SDI Exempt: EAF Exempt: Male/Female: Supervisor ID: Spouse Name: Emergency Contact Name: Emergencey Phone: Note: Hourly/Salary/Commission: Pay Periods Per Year: County Name: County Name 2: School District: E-mail: Region: W-5 On File: W-5 Married: W-5 Both Spouses Filing:
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