CHECK NUMBER/CODEDATE TRANSACTION DESCRIPTION(–) PAYMENT/ DEBIT (+) DEPOSIT/ CREDIT BALANCE✓Ending BalanceStarting BalanceBUSINESS CHECK REGISTER
NEW EMPLOYEE HIRE CHECK LISTEMPLOYEE NAME Onboarding tasks New hire paperwork checklist Welcome pack for new employee Done Notapplicable Note Input new hire’s information into the payrollsystem accurately Create profiles in the necessary internal systems Arrange office access cards or passwords Set up all IT accounts (including email accounts, software installations, and access to shared drives) Conduct health and safety training A company overview that includes mission, vision,values, and organizational structure An employee handbook outlining policies, procedures,and code of conduct The first week’s schedule with a full orientation and introduction phase itinerary A directory of relevant team members, departments,and their roles Signed and documented offer letter and contract,outlining the terms and conditions of employment W -4 Tax forms I-9 Forms. Copies of identification documents (e.g.,passport or driver’s license) Emergency contact information Benefits enrollment forms (including health insurance, pension, and other benefit plans) Non-disclosure agreement (NDA) or confidentiality agreement ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐☐ ☐ ☐ ☐ ☐ ☐ ☐
Continuous feedback and support Accessibility and inclusivity measures Welcome announcement for new employee Cultural integration and social engagement Mentorship or buddy system implementation Professional development and training plans Provide insights into the company culture, traditions,and values through cultural onboarding sessions Organize informal gatherings or team-buildingactivities to facilitate social integration within the team Depending on the role, lay out specific training ordevelopment courses that align with the job description andfuture growth within the organization Offer access to online platforms or in-house training materials to encourage continuous learning Pair a new employee with a seasoned team member toease the transition, and to offer guidance, insights, anda friendly point of contact Schedule regular check-ins including HR and immediatesupervisors during the first few months to provide continuous support and address any concerns A formal review after the initial 90 days to assess progress, alignment with company goals, and set further development plans Email or a notice on the internet introducing the newhire, their role, and background A scheduled meeting with direct teammates andsupervisors, either in person or virtually Add new employee to the organizational chart ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐
Create a planned transition from the onboarding programinto full engagement with the team, marked by clearmilestones and communicated expectations Gather insights from the new hire on their experience with the onboarding process, for continuous improvement Ensure that any specific requirements related todisabilities are addressed Provide training on diversity and inclusivity to create a respectful and supportive environment ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ Exit strategy from the onboarding program
STANDARD NEW EMPLOYMENT APPLICATION It is our policy to comply with all applicable state and federal laws prohibiting discrimination in employment based on race, age, color, sex, religion, national origin, disability or other protected classifications. Please carefully read and answer all questions. You will not be considered for employment if you fail to completely answer all the questions on this application. You may attach a résumé, but all questions must be answered. “ REFERENCES SPECIAL SKILLS QUALIFICATIONSPERSONAL DATA Name (last, first, middle) Street Address and/or MailingAddress Home Telephone Number Date you can start work POSITION INFORMATIONPosition applying for Other School Salary Desired Check all that you are willing to work Days Evenings Business Telephone Number City State Cellular Telephone Number Hours: Full Time Swing Part Time Graveyard Status: Regular Weekends Temporary Are you authorized to work in the U.S. on an unrestricted basis? Yes No Have you ever been convicted of a felony? (Convictions will not necessarilydisqualify an applicant for employment.) Yes No If yes, explain: Have you been told the essential functions of the job or have you been viewed a copy of the job description listing the essential functionsf the job? Yes No Can you perform these essential functions of the job with or without reasonable accommodation? Yes No Zip Do you have a High School Diploma or GED? Yes No Please list three professional references not related to you, with full name, address, phone number, and relationship. If you don’t have three professional references, then list personal, unrelated references. Name Address/City/State Phone Relationship List any special skills or experience that you feel would help you in the position that you are applying for(leadership, organizations/teams, etc. Please list any education or training you feel relates to the position applied for that would help you perform the work, such as schools, colleges, degrees, vocational or technical programs, and military training. School Name Degree Address/City/State School Department
Applicant Signature WORK HISTORY Job Title #1 May we contact your present employer? Yes No Date N/ACity City City City Duties:Duties:Duties:Duties:Company Name Company Name Company Name Company Name Reason for Leaving Reason for Leaving Reason for Leaving Reason for Leaving State State State State Supervisor’s Name Supervisor’s Name Supervisor’s Name Supervisor’s Name Start Date (mo/day/yr) Start Date (mo/day/yr) Start Date (mo/day/yr) Starting Salary Starting Salary Starting Salary Starting Salary Zip Zip Zip Zip Ending Salary Ending Salary Ending Salary Ending Salary Phone Number Phone Number Phone Number Phone Number End Date (mo/day/yr) End Date (mo/day/yr) End Date (mo/day/yr) Start with your present or most recent employment and work back. Use separate sheet if necessary. (INCLUDE PAID AND UNPAID POSITIONS)Start Date (mo/day/yr) End Date (mo/day/yr) Job Title #2 Job Title #3 Job Title #4 I certify that the facts set forth in this Application for Employment are true and complete to the best of my knowledge. I understand that if I am employed, false statements, omissions or misrepresentations may result in my dismissal. I authorize the Employer to make an investigation ofany of the facts set forth in this application and release the Employer from any liability. The employer may contact any listed references on thisapplication. I acknowledge and understand that the company is an “at will” employer. Therefore, any employee (regular, temporary, or other type of category employee) may resign at any time, just as the employer may terminate the employment relationship with any employee at any time, with orwithout cause, with or without notice to the other party.
Address City or town, state, and ZIP codeFirst name and middle initial Last nameCat. No. 10220QForm OMB No. 1545-0074 (2023) If not, to ensure you get credit for your earnings, contact SSA at 800-772-1213or go to www.ssa.gov.or (Check only if you’re unmarried and pay more than half the costs of keeping up a home for yourself and a qualifying individual.)Form W-4Department of the TreasuryInternal Revenue Service Employee’s Withholding CertificateFor Privacy Act and Paperwork Reduction Act Notice, see page 3.Complete Form W-4 so that your employer can withhold the correct federal income tax from your pay.Give Form W-4 to your employer. Your withholding is subject to review by the IRS.2023Step 5:Sign HereStep 1:Enter Personal InformationEmployersOnlyW-4(c) (a) Single or Married filing separatelyMarried filing jointly Qualifying surviving spouseHead of household (b) Social security numberDoes your name match thename on your social securitycard?Employee’s signature Date (This form is not valid unless you sign it.)Complete Steps 2–4 ONLY if they apply to you; otherwise, skip to Step 5. See page 2 for more information on each step, who canclaim exemption from withholding, other details, and privacy.Step 2: Complete this step if you (1) hold more than one job at a time, or (2) are married filing jointly and your spouse Multiple Jobs also works. The correct amount of withholding depends on income earned from all of these jobs.or Spouse Do only one of the following.Works(a)Reserved for future use.(b)Use the Multiple Jobs Worksheet on page 3 and enter the result in Step 4(c) below; or (c) If there are only two jobs total, you may check this box. Do the same on Form W-4 for the other job. This option is generally more accurate than (b) if pay at the lower paying job is more than half of the pay at the higher paying job. Otherwise, (b) is more accurate ..................TIP: If you have self-employment income, see page 2.Complete Steps 3–4(b) on Form W-4 for only ONE of these jobs. Leave those steps blank for the other jobs. (Your withholding will be most accurate if you complete Steps 3–4(b) on the Form W-4 for the highest paying job.)Step 3: If your total income will be $200,000 or less ($400,000 or less if married filing jointly): Claim Multiply the number of qualifying children under age 17 by $2,000$Dependent and Other Multiply the number of other dependents by $500 .....$Credits Add the amounts above for qualifying children and other dependents. You may add to this the amount of any other credits. Enter the total here ..........3$Step 4 (a) Other income (not from jobs). If you want tax withheld for other income you (optional): expect this year that won’t have withholding, enter the amount of other income here. Other This may include interest, dividends, and retirement income ........4(a)$Adjustments(b) Deductions. If you expect to claim deductions other than the standard deduction and want to reduce your withholding, use the Deductions Worksheet on page 3 and enter the result here .......................4(b)$(c)Extra withholding. Enter any additional tax you want withheld each pay period ..4(c)$Employer’s name and address First date ofemploymentUnder penalties of perjury, I declare that this certificate, to the best of my knowledge and belief, is true, correct, and complete.Employer identificationnumber (EIN)
Form W-4 (2023)Page 2General Instructions Specific InstructionsSection references are to the Internal Revenue Code. Complete Form W-4 so that your employer can withhold thecorrect federal income tax from your pay. If too little iswithheld, you will generally owe tax when you file your taxreturn and may owe a penalty. If too much is withheld, youwill generally be due a refund. Complete a new Form W-4when changes to your personal or financial situation wouldchange the entries on the form. For more information onwithholding and when you must furnish a new Form W-4, see Pub. 505, Tax Withholding and Estimated Tax. Exemption from withholding. You may claim exemption from withholding for 2023 if you meet both of the following conditions: you had no federal income tax liability in 2022 and you expect to have no federal income tax liability in 2023. You had no federal income tax liability in 2022 if (1) your total tax on line 24 on your 2022 Form 1040 or 1040-SR is zero (or less than the sum of lines 27, 28, and 29), or (2) you were not required to file a return because your income was below the filing threshold for your correct filing status. If you claim exemption, you will have no income tax withheld from your paycheck and may owe taxes and penalties when you file your 2023 tax return. To claim exemption from withholding, certify that you meet both of the conditions above by writing “Exempt” on Form W-4 in the space below Step 4(c). Then, complete Steps 1(a), 1(b), and 5. Do not complete any other steps. You will need to submit a new Form W-4 by February 15, 2024.Your privacy. If you have concerns with Step 2(c), you may choose Step 2(b); if you have concerns with Step 4(a), you may enter an additional amount you want withheld per pay period in Step 4(c). Self-employment. Generally, you will owe both income and self-employment taxes on any self-employment income you receive separate from the wages you receive as an employee. If you want to pay income and self-employment taxes through withholding from your wages, you should enter the self-employment income on Step 4(a). Then compute your self-employment tax, divide that tax by the number of pay periods remaining in the year, and include that resulting amount per pay period on Step 4(c). You can also add half of the annual amount of self-employment tax to Step 4(b) as a deduction. To calculate self-employment tax, you generally multiply the self-employment income by 14.13% (this rate is a quick way to figure your self-employment tax and equals the sum of the 12.4% social security tax and the 2.9% Medicare tax multiplied by 0.9235). See Pub. 505 for more information, especially if the sum of self-employment income multiplied by 0.9235 and wages exceeds $160,200 for a given individual.Nonresident alien. If you’re a nonresident alien, see Notice 1392, Supplemental Form W-4 Instructions for Nonresident Aliens, before completing this form.For the latest information about developments related toForm W-4, such as legislation enacted after it was published,go to www.irs.gov/FormW4.Step 1(c). Check your anticipated filing status. This willdetermine the standard deduction and tax rates used tocompute your withholding.Step 2. Use this step if you (1) have more than one job at the same time, or (2) are married filing jointly and you and your spouse both work. If you (and your spouse) have a total of only two jobs, you may check the box in option (c). The box must also be checked on the Form W-4 for the other job. If the box is checked, the standard deduction and tax brackets will be cut in half for each job to calculate withholding. This option is roughly accurate for jobs with similar pay; otherwise, more tax than necessary may be withheld, and this extra amount will be larger the greater the difference in pay is between the two jobs. This step provides instructions for determining the amount of the child tax credit and the credit for otherdependents that you may be able to claim when you file yourtax return. To qualify for the child tax credit, the child must be under age 17 as of December 31, must be your dependent who generally lives with you for more than half the year, and must have the required social security number.You may be able to claim a credit for other dependents forwhom a child tax credit can’t be claimed, such as an olderchild or a qualifying relative. For additional eligibilityrequirements for these credits, see Pub. 501, Dependents,Standard Deduction, and Filing Information. You can alsoinclude other tax credits for which you are eligible in thisstep, such as the foreign tax credit and the education taxcredits. To do so, add an estimate of the amount for the yearto your credits for dependents and enter the total amount inStep 3. Including these credits will increase your paycheckand reduce the amount of any refund you may receive whenyou file your tax return. Step 4 (optional).Step 4(a). Enter in this step the total of your other estimated income for the year, if any. You shouldn’t includeincome from any jobs or self-employment. If you completeStep 4(a), you likely won’t have to make estimated taxpayments for that income. If you prefer to pay estimated taxrather than having tax on other income withheld from yourpaycheck, see Form 1040-ES, Estimated Tax for Individuals.Step 4(b). Enter in this step the amount from the Deductions Worksheet, line 5, if you expect to claim deductions other than the basic standard deduction on your 2023 tax return and want to reduce your withholding to account for these deductions. This includes both itemized deductions and other deductions such as for student loan interest and IRAs.Step 4(c). Enter in this step any additional tax you want withheld from your pay each pay period, including any amounts from the Multiple Jobs Worksheet, line 4. Entering an amount here will reduce your paycheck and will either increase your refund or reduce any amount of tax that you owe.Purpose of FormFuture DevelopmentsFor your State’s W-4 Forms:Click Here Now
Employment Eligibility Verification USCIS Department of Homeland Security U.S.Citizenship and Immigration Services Form I-9OMB No.1615-0047Expires 07/31/2026 I am aware that federal lawprovides for imprisonment and/orfines for false statements, or theuse of false documents, inconnection with the completion ofthis form. I attest, under penaltyof perjury, that this information,including my selection of the boxattesting to my citizenship orimmigration status, is true andcorrect. List A Additional Information List B For reverification or rehire, complete Supplement B, Reverification and Rehire on Page 4. List C START HERE: Employers must ensure the form instructions are available to employees when completing this form. Employers are liable forfailing to comply with the requirements for completing this form. See below and the Instructions. ANTI-DISCRIMINATION NOTICE: All employees can choose which acceptable documentation to present for Form I-9. Employers cannot ask employees for documentation to verify information in Section 1, or specify which acceptable documentation employees must present for Section 2 or Supplement B, Reverification and Rehire. Treating employees differently based on their citizenship, immigration status, or national origin may be illegal. Section 2. Employer Review and Verification: Employers or their authorized representative must complete and sign Section 2 within three business days after the employee's first day of employm ent, and must physically examine, or examine consistent with an alternative procedure authorized by the Secretary of DHS, documentation from List A OR a combination of documentation from List B and List C. Enter any additional documentation in the Additional Information box; see Instructions. Section 1. Employee Information and Attestation:day of employment first Employees must complete and sign Section 1 of Form I-9 no later than the, but not before accepting a job offer. Signature of Employee Issuing Authority Document Number (if any)Expiration Date (if any) Issuing Authority Document Number (if any)Expiration Date (if any) Issuing Authority Document Number (if any)Expiration Date (if any) Last Name (Family Name) Date of Birth (mm/dd/yyyy) Address (Street Number and Name) Employer's Business or Organization Name U.S. Social Security Number Last Name, First Name and Title of Employer or Authorized Representative First Name (Given Name) Apt. Number (if any) City or Town Employee's Email Address Middle Initial (if any) Today's Date (mm/dd/yyyy) State Employer's Business or Organization Address, City or Town, State, ZIP Code Other Last Names Used (if any) First Day of Employment(mm/dd/yyyy): ZIP Code Employee's Telephone Number Check one of the following boxes to attest to your citizenship or immigration status (See page 2 and 3 of the instructions.): 1. A citizen of the United States 2. A noncitizen national of the United States (See Instructions.) 3. A lawful permanent resident (Enter USCIS or A-Number.) 4. A noncitizen (other than Item Numbers 2. and 3. above) authorized to work until (exp. date, if any) If you check, enter one of these: Today's Date (mm/dd/yyyy) Document Title 1 Document Title 2 (if any) Document Title 3 (if any) Item Number 4.USCIS A-Number Form I-94 Admission Number AND Certification: I attest, under penalty of perjury, that (1) I have examined the documentation presented by the above-namedemployee, (2) the above-listed documentation appears to be genuine and to relate to the employee named, and (3) to thebest of my knowledge, the employee is authorized to work in the United States. If a preparer and/or translator assisted you in completing Section 1, that person MUST complete the Preparer and/or Translator Certification on Page 3. Foreign Passport Number and Country of Issuance OR OR OR Signature of Employer or Authorized Representative Check here if you used an alternative procedure authorized by DHS to examine documents. Form I-9 Edition 08/01/23 Page 1 of 3
LISTS OF ACCEPTABLE DOCUMENTS All documents containing an expiration date must be unexpired.*Documents extended by the issuing authority are considered unexpired.Employees may present one selection from List A or acombination of one selection from List B and one selection from List C.Acceptable Receipts Examples of many of these documents appear in the Handbook for Employers (M-274). 6.3.4.1.2.5.LIST A Documents that Establish Both Identity and Employment Authorization OR 1.2.3.4.5.6.7.8.9.10.11.12.LIST B Documents that Establish Identity AND 1.2.3.4.5.6.7.LIST C Documents that Establish EmploymentAuthorization U.S. Passport or U.S. Passport CardPermanent Resident Card or AlienRegistration Receipt Card (Form I-551)Foreign passport that contains atemporary I-551 stamp or temporaryI-551 printed notation on a machine-readable immigrant visaEmployment Authorization Documentthat contains a photograph (Form I-766)For an individual temporarily authorizedto work for a specific employer becauseof his or her status or parole:a.Foreign passport; andb.Form I-94 or Form I-94A that hasthe following:(1)The same name as thepassport; and(2)An endorsement of theindividual's status or parole aslong as that period ofendorsement has not yetexpired and the proposedemployment is not in conflictwith any restrictions orlimitations identified on the form.Passport from the Federated States ofMicronesia (FSM) or the Republic of theMarshall Islands (RMI) with Form I-94 orForm I-94A indicating nonimmigrantadmission under the Compact of FreeAssociation Between the United Statesand the FSM or RMISchool record or report cardClinic, doctor, or hospital recordDay-care or nursery school record Receipt for a replacement of a lost,Receipt for a replacement of a lost, stolen, or stolen, or damaged List A document.OR damaged List B document. Form I-94 issued to a lawfulpermanent resident that contains anI-551 stamp and a photograph of theindividual. Form I-94 with “RE” notation orrefugee stamp issued to a refugee.*Refer to the Employment Authorization Extensions page on I-9 Central for more information.Driver's license or ID card issued by a State oroutlying possession of the United Statesprovided it contains a photograph orinformation such as name, date of birth,gender, height, eye color, and addressID card issued by federal, state or localgovernment agencies or entities, provided itcontains a photograph or information such asname, date of birth, gender, height, eye color,and addressSchool ID card with a photographVoter's registration cardU.S. Military card or draft recordMilitary dependent's ID cardU.S. Coast Guard Merchant Mariner CardNative American tribal documentDriver's license issued by a Canadiangovernment authorityA Social Security Account Number card,unless the card includes one of the followingrestrictions:(1)NOT VALID FOR EMPLOYMENT(2)VALID FOR WORK ONLY WITHINS AUTHORIZATION(3)VALID FOR WORK ONLY WITHDHS AUTHORIZATIONCertification of report of birth issued by theDepartment of State (Forms DS-1350,FS-545, FS-240)Original or certified copy of birth certificateissued by a State, county, municipalauthority, or territory of the United Statesbearing an official sealNative American tribal documentU.S. Citizen ID Card (Form I-197)Identification Card for Use of ResidentCitizen in the United States (Form I-179)Employment authorization documentissued by the Department of HomelandSecurityFor examples, see Section 7 andSection 13 of the M-274 onuscis.gov/i-9-central.The Form I-766, EmploymentAuthorization Document, is a List A, ItemNumber 4. document, not a List Cdocument.Receipt for a replacement of a lost, stolen, ordamaged List C document. For persons under age 18 who areunable to present a documentlisted above: May be presented in lieu of a document listed above for a temporary period.For receipt validity dates, see the M-274. Form I-9 Edition 08/01/23 Page 2 of 3
Supplement A, Preparer and/or Translator Certification for Section 1 USCIS Form I-9Supplement ADepartment of Homeland Security U.S. Citizenship and Immigration Services Form I-9 Edition 08/01/23 OMB No. 1615-0047Expires 07/31/2026 Page 3 of 3 Last Name from First Name from Middle initial (if any) from (Family Name) (Given Name)Section 1. Section 1. Section 1. I attest, under penalty of perjury, that I have assisted in the completion of Section 1 of this form and that to the best of myknowledge the information is true and correct. I attest, under penalty of perjury, that I have assisted in the completion of Section 1 of this form and that to the best of myknowledge the information is true and correct. I attest, under penalty of perjury, that I have assisted in the completion of Section 1 of this form and that to the best of myknowledge the information is true and correct. I attest, under penalty of perjury, that I have assisted in the completion of Section 1 of this form and that to the best of myknowledge the information is true and correct. Instructions: This supplement must be completed by any preparer and/or translator who assists an employee in completing Section 1 ofForm I-9. The preparer and/or translator must enter the employee's name in the spaces provided above. Each preparer or translatormust complete, sign, and date a separate certification area. Employers must retain completed supplement sheets with the employee'scompleted Form I-9. Address Address Address Address Last Name Last Name Last Name Last Name Signature of Preparer or Translator Signature of Preparer or Translator Signature of Preparer or Translator Signature of Preparer or Translator First Name First Name First Name First Name City or Town City or Town City or Town City or Town Date Date Date Date State State State State ZIP Code ZIP Code ZIP Code ZIP Code Middle Initial Middle Initial Middle Initial Middle Initial (Family Name) (Street Number and Name) (Family Name) (Street Number and Name) (Family Name) (Street Number and Name) (Family Name) (Street Number and Name) (Given Name) (Given Name) (Given Name) (Given Name) (mm/dd/yyyy) (mm/dd/yyyy) (mm/dd/yyyy) (mm/dd/yyyy) (if any) (if any) (if any) (if any)
Employee’s Initials - _____ Employer’s initials - ______ Page 1 EMPLOYMENT CONTRACT This employment agreement (“Agreement”) is made and effective as of ___________________, 20___ by andbetween: Employer: _________________________________, (“Employer”) with a mailing address of ______________________________________, and Employee: __________________________________, (“Employee”) with a mailing address of ______________________________________. WHEREAS the Employer intends to hire the Employee for the Position and the Employee desires to provide their services to the Employer for payment. IN CONSIDERATION of promises and other good and valuable consideration, the parties agree to the following: I. EMPLOYEE DUTIES. The Employee agrees that they will act in accordance with this Agreement and with the best interests of the Employer in mind, which may or may not require them to present the best of their skills, experience, and talents, to perform all the duties required of thePosition. In carrying out the duties and responsibilities of their Position, the Employee agrees to adhereto any and all policies, procedures, rules, regulations, as administered by the Employer. In addition, theEmployee agrees to abide by all local, county, State, and Federal laws while employed by the Employer. II. RESPONSIBILITIES. The Employee shall be given the job title of ___________________, (“Position”) which shall involve: __________________________________________________. The Employer may also assign duties to the Employee from time to time by the Employer. The Employee shall be expected to work ☐ full-time ☐ part-time. III. EMPLOYMENT PERIOD. The Employer agrees to hire the Employee: (check one) ☐ - At-Will which means this Agreement may be terminated at any time by either the Employee or Employer. After termination by any of the Parties, neither will have any obligation other than the non-disclosure of the Employer’s proprietary information as outlined in Section XII and any non-compete listed in Section XIII. a.) Employee’s Termination. The Employee shall have the right to terminate this Agreement by providing at least ___ days’ notice. If the Employee should terminate this Agreement, he or she shall be entitled to severance, equal to their pay at the time of termination, for a period of ___________________. b.) Employer’s Termination. The Employer shall have the right to terminate this Agreement by providing at least ___ days’ notice. If the Employer should terminate this Agreement, the Employee shall be entitled to severance, equal to their pay at the time of termination, for a period of ___________________.
Employee’s Initials - _____ Employer’s initials - ______ Page 2 ☐☐☐☐ ☐ - For a Specified Time-Period beginning on the ___ day of ___________________, 20___ and ending on the ___ day of ___________________, 20___. At the end of said time-period, both parties will no longer have any obligation to one another. a.) Employee’s Termination. The Employee ☐ *shall ☐ shall not have the right to terminate this Agreement. *If allowed, the Employee shall be required to provide at least ___ days’ notice. If the Employee should terminate this Agreement before the expiration date, he or she shall be entitled to severance, equal to their pay at the time of termination, for a period of ___________________. b.) Employer’s Termination. The Employer ☐ *shall ☐ shall not have the right to terminate this Agreement. *If allowed, the Employer shall be required to provide at least ___ days’ notice. If the Employer should terminate this Agreement, the Employee shall be entitled to severance, equal to their pay at the time of termination, for a period of ___________________. IV. PAY. As compensation for the services provided, the Employee shall be paid ___________________ dollars ($___________________) ☐ per hour ☐ salary on an annual basis (“Compensation”). The Compensation is a gross amount that is subject to all local, State, Federal, and any other taxes and deductions as prescribed by law. Payment shall be distributed to the Employee on a ☐ weekly ☐ bi-weekly ☐ monthly ☐ quarterly ☐ annual basis. a.) Commissions. In addition to the aforementioned Pay, the Employee shall be entitled to commissions that are to be paid every ___________________ and shall be calculated as follows: __________________________________________________ ______________________________________________________________________________________________________________________________________ b.) Bonus. The Employee shall be entitled to Bonuses on a ___________________ basis which is to be calculated as follows: _________________________________ ___________________________________________________________________________ V. EMPLOYEE BENEFITS. During the period of employment, the Employee shall be eligible to participate in benefits established by the Employer. These include _______________________ ________________________________________________________________________________________________________________________________________________________ The aforementioned benefits may change at any time by the Employer. VI. OUT-OF-POCKET EXPENSES. The Employer agrees to reimburse the Employee for any expenses that are incurred, including: (check all that apply) - Travel - Food - Lodging - Other: _____________________________________________________________
Employee’s Initials - _____ Employer’s initials - ______ Page 3 VII. OWNERSHIP INTEREST. This Agreement shall ☐ not include ☐ *include partial ownership in the business operations of the Employer. *If such ownership is offered, the details shall be stated in an attached Exhibit. VIII. TRIAL PERIOD. Other than certain benefits prescribed by law, the Employee will not be eligible for Benefits, Vacation Time, or Personal Leave until after the first ___ days of employment ("Trial Period"). In addition, the Employee will not be eligible for vacation time, sick leave, or any time off that would be paid or unpaid. IX. VACATION TIME. After the Trial Period is complete, the Employee is entitled to ___ days off per year of which is required to be mutually benefiting of the Employer and the Employee. It is required for the Employee to give notice before scheduling their vacation in accordance with Company policy. Any unused Vacation Time shall be (check one): ☐ - Converted to cash at the end of the year at a rate of $___ per day. ☐ - Eligible to rollover up to ___ days to the next year. ☐ - Forfeited at the end of the year. ☐ - Other: _____________________________________________________________ X. PERSONAL LEAVE. After the Trial Period, the Employee shall be eligible for ___ days of ☐ paid ☐ unpaid time off per year for personal and/or medical issues. Any unused Personal Leave shall be: (check one) ☐ - Converted to cash at the end of the year at a rate of $___ per day. ☐ - Eligible to rollover up to ___ days to the next year. ☐ - Forfeited at the end of the year. ☐ - Other: _____________________________________________________________ If for any reason the Employee depletes their amount of days of personal leave in a given year, he or she ☐ may ☐ may not be able to use any remaining vacation time. XI. FEDERAL HOLIDAYS. The Employee shall be entitled to ___ federal holidays per calendar year. This is subject to change by the Employer from time to time. If for any reason the Employee should request a Federal Holiday off, the Employer shall determine if the Employee may do so and if it shall be taken from either the Employee’s Personal Leave or Vacation Time. Federal Holidays are determined by the Employer and may change every calendar year. XII. CONFIDENTIALITY. The Employee understands and agrees to keep any and all information confidential regarding the business plans, inventions, designs, products, services, processes, trade secrets, copyrights, trademarks, customer information, customer lists, prices, analytics data, costs, affairs, and any other information that could be considered proprietary to the Employer ("Confidential Information"). The Employee understands that disclosure of any such Confidential Information, either directly or indirectly, shall result in litigation with the Employer eligible for equitable relief to the furthest extent of the law, including but not limited to filing claims for losses and/or damages. In addition, if it is found that the Employee divulged
Employee’s Initials - _____ Employer’s initials - ______ Page 4 Confidential Information to a third (3rd) party with the Employer shall be entitled any andall reimbursement for their legal and attorney’s fees. a.) Post Termination. After the Employee has terminated their employment with the Employer, the Employee shall be bound to Section XII of this Agreement for a period of ____ ☐ Months ☐ Years (“Confidentiality Term”). If the Confidentiality Term is beyond any limit set by local, State, or Federal laws, then the Confidentiality Term shall be the maximum allowed legal time frame. XIII. NON-COMPETE. (check one) ☐ - There shall be no Non-Compete established in this Agreement. ☐ - During the term of employment, the Employee understands that he or she willbe subject to learning proprietary information, including trade secrets, which couldbe applied to competitors of the employer. Therefore, in order to protect thefiduciary interests of the Employer, the Employee agrees to: (check all that apply) ☐ - Withhold from working in the following industry(ies): ___________________ ________________________________________________________________ ☐ - Withhold from working for the following employer(s): ___________________ ________________________________________________________________ ☐ - Withhold from working in the same industry(ies) as the Employer in the following area(s): __________________________________________________ ________________________________________________________________ ☐ - Other: _______________________________________________________ ________________________________________________________________ This Non-Compete shall be in effect for _______ ☐ Months ☐ Years following the date of Employee’s termination. This Section shall be applied to the Employee engaging, directly or indirectly, anycompetitive industry. This includes, but is not limited to: a.) Communicating with related business owners, partners, members, officers, or agents; b.) Being employed by or consulting any related business; c.) Being self-employed in a related business; or d.) Soliciting any customer, client, affiliate, vendor, or any other relationship of the Employer. XIV. EMPLOYEE’S ROLE. The Employee ☐ shall ☐ shall not have the right to act in the capacity of the Employer. This includes, but is not limited to, making written or verbal agreements with any customer, client, affiliate, vendor, or third (3rd) party.
Employee’s Initials - _____ Employer’s initials - ______ Page 5 XV. APPEARANCE. The Employee must appear at the Employer’s desired workplace at thetime scheduled. If the Employee does not appear, for any reason, on more than ____separate occasions in a 12-month calendar period, the Employer has the right to terminatethis Agreement immediately. In such event, the Employee would not be granted severance asstated in Section III. XVI. DISABILITY. If for any reason the Employee cannot perform their duties, by physical or mental disability, the Employer may terminate this Agreement by giving the Employee ____ days’ written notice. XVII. COMPLIANCE. The Employee agrees to adhere to all sections of this Agreement in addition to any rules, regulations, or conduct standards of the Employer, including obeying all local and federal laws. If the Employee does not adhere to this Agreement, companypolicies, including any task or obligation that is related to the responsibilities of theirPosition, the Employer may terminate this Agreement without severance as stated inSection III. XVIII. RETURN OF PROPERTY. The Employee agrees to return any and all property of the Employer upon the termination of employment. This includes, but is not limited to, equipment, electronics, records, access, notes, data, tests, vehicles, reports, models, or anyproperty that is requested by the Employer. XIX. NOTICES. All notices that are to be sent under this Agreement shall be done in writingand to be delivered to recipient. The aforementioned addresses may be changed with theact of either party providing written notice. XX. AMENDMENTS. This Agreement may be modified or amended under the condition thatany such amendment is attached and authorized by all parties. XXI. SEVERABILITY. This Agreement shall remain in effect in the event a section or provision is unenforceable or invalid. All remaining sections and provisions shall be deemed legally binding unless a court rules that any such provision or section is invalid or unenforceable,thus, limiting the effect of another provision or section. In such case, the affected provisionor section shall be enforced as so limited. XXII. WAIVER OF CONTRACTUAL RIGHTS. If the Employer or Employee fails to enforce a provision or section of this Agreement, it shall not be determined as a waiver or limitation. Either party shall remain the right to enforce and compel the compliance of this Agreementto its fullest extent. XXIII. GOVERNING LAW. This Agreement shall be governed under the laws in the State of___________________. XXIV. ENTIRE AGREEMENT. This Agreement, along with any attachments or addendums, represents the entire agreement between the parties. Therefore, this Agreement supersedes any prior agreements, promises, conditions, or understandings between theEmployer and Employee. _____________________________________Employer Signature Date______________________________________Employee Signature Date
EMPLOYEE EMERGENCY CONTACT FORM Name ______________________________________________________________________________ Department __________________________________________________________________________ Personal Contact Info: Home Address________________________________________________________________________ City, State, ZIP _______________________________________________________________________ Home Telephone # ____________________________ Cell # __________________________________ Emergency Contact Info: (1) Name_______________________________________ Relationship___________________________ Address _____________________________________________________________________________ City, State, ZIP _______________________________________________________________________ Home Telephone # ____________________________ Cell # __________________________________ Work Telephone # _______________________________ Employer _____________________________ (2) Name_______________________________________ Relationship___________________________ Address _____________________________________________________________________________ City, State, ZIP _______________________________________________________________________ Home Telephone # ____________________________ Cell # __________________________________ Work Telephone # _______________________________ Employer _____________________________ Medical Contact Info: Doctor Name. ______________________________________ Phone # __________________________ Dentist Name ______________________________________ Phone # __________________________ I have voluntarily provided the above contact information and authorize____________________________________ and its representatives to contact any of the above on my behalf in the event of an emergency. Employee Signature __________________________ Date __________________________________
DIRECT DEPOSIT AUTHORIZATION FORM: Please print and complete ALL the information below. Employee’s Signature: ______________________________________________Date: ___________________________ ______________________ [] is hereby authorized to directly deposit my pay to theaccount listed above. This authorization will remain in effect until I modify or cancel itin writing. __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ $ ____________ ___________% or Entire Paycheck Checking Savings (Check One) Name: Address: City, State, Zip: Name of Bank:Account #: 9-Digit Routing #Amount: Type of Account: Attach a voided check for each bank account to which funds should be deposited (if necessary) Company Name
Employee Direct Deposit Enrollment Form ATTENTION PAYROLL MANAGER: Memo__________________________ Payroll Manager – Please complete this section and send a copy to ADP for enrollment. (Please print.) Routing/Transit # (A 9-digit number always betweenthese two marks) Checking Account # Company Code: _______ Company Name: _____________________________ Employee File Number: ________Payroll Mgr. Name: ____________________________ Payroll Mgr. Signature: ____________________________ Check # (this number matches the numberin the upper right corner of thecheck – not needed for sign-up)To enroll in Full Service Direct Deposit, simply fill out this form and give to your payroll manager. Attach a voided check for each checking account - not adeposit slip. If depositing to a savings account, ask your bank to give you the Routing/Transit Number for your account. It isn’t always the same as the numberon a savings deposit slip. This will help ensure that you are paid correctly. Below is a sample check MICR line, detailing where the information necessary to complete this form can be found. I hereby authorize ADP to deposit any amounts owed me, as instructed by my employer, by initiating credit entries to my account at the financial institution(hereinafter “Bank”) indicated on this form. Further, I authorize Bank to accept and to credit any credit entries indicated by ADP to my account. In the even thatADP deposits funds erroneously into my account, I authorize ADP to debit my account for an amount not to exceed the original amount of the erroneous credit. This authorization is to remain in full force and effect until ADP and Bank have received written notice from me of its termination in such time and in such manner as to afford ADP and Bank reasonable opportunity to act on it. |: 012345678|: 123456789” 0101 1.2.3.Employee Name:Employee Signature: Bank Name/City/State: ____________________________________________________________________Routing Transit #: __ __ __ __ __ __ __ __ __ Account Number: _________________________________ 1 Checking 1 Savings 1 Other I wish to deposit: $ _______.____ or 1Entire Net Amount Bank Name/City/State: ____________________________________________________________________Routing Transit #: __ __ __ __ __ __ __ __ __ Account Number: _________________________________ 1Checking 1Savings 1Other I wish to deposit: $ _______.____ or 1Entire Net Amount Bank Name/City/State: ____________________________________________________________________Routing Transit #: __ __ __ __ __ __ __ __ __ Account Number: _________________________________ 1Checking 1 Savings 1Other I wish to deposit: $ _______.____ or 1Entire Net Amount Social Security #: __ __ __ - __ __ - __ __ __ __ Date: Account Information IMPORTANT! Please read and sign before completing and submitting. The last item must be for the remaining amount owed to you. To distribute to more accounts, please complete another form. Make sure to indicate what kind of account, along with amount to be deposited, if less than your total net paycheck. Employers must keep each original employee enrollment form on file as long as the employee is using FSDD, and for two years thereafter. ADP is a registered trademark of ADP of North America Inc. Full Service Direct Deposit (FSDD) is a service mark of Automatic Data Processing,Inc. 02-184-049 10M Printed in USA ©1999, 1998 Automatic Data Processing, Inc.Made Fillable by eForms
Direct Deposit Enrollment/Change Form* Company Name and/or Client Number ________________________________________________________Employee/Worker Name_____________________________ Employee/Worker Number __________ Employee/Worker: Retain a copy of this form for your records. Return the original to your employer/company. Employer/Company: Please retain a copy of this document fo r your records. Note:COMPLETE TO ENROLL / ADD / CHANGE BANK ACCOUNTS y ––PLEASE PRINT IN BLACK/BLUE INK ONLY not acceptable. CLEARLY CheckingNumber Checking Number CheckingNumber Savings Savings Savings 0 Remainder of Net Pay Routing/Transit Routing/Transit Routing/Transit I wish to deposit (check one): _____% of Net Specific Dollar Amount $ _____________ .0I author ize my employer/company to deposit my earni ngs into the b ank account(s) specified above and, if necessary, to electronicallydebit my account to correct erroneous entries. I certify my account(s) allow these transactions. Furthermore, I certify that the above listedaccount number accurately reflects my intended receiving account. I agree that direct deposit transactions I authorize comply with allapplicable laws. My signature below indicates that I am agreeing that I am either the accountholder or have the authority of theaccountholder to authorize my employer/company make direct deposits into the named account. I understand that this authorization willremain in full force and effect until I notify Company in writing that I wish to revoke my authorization.I understand that the Companyrequires at least 5 business days prior notice to cancel this authorization.CLEARLY I confirm that the above named employee/worker has added or changed a bank account for direct deposit transactions processed byPaychex, Inc. I have reviewed the information provided and it is accurate to the best of my knowledge. My signature below indicates thatI have the authority to execute this document on behalf of the Client. CONFIRMATION STATEMENT Digital or Electronic Signatures are* All fields are re MM/DD/YY quired except Employee/Worker Number.** Certain accounts may have restrictions on deposits and withdrawals. Check with your bank for more information specific to your account. Type of AccountTpe of AccountType of AccountChecking/Savings Account Number**Financial Institution (“Bank”) NameAccount holder's Name: Account holder's Name:Account holder's Name:Checking/Savings Account Number** Financial Institution (“Bank”) NameI wish to deposit (check one): _____% of Net Specific Dollar Amount $ _____________ .0 Checking/Savings Account Number**Financial Institution (“Bank”) Name I wish to deposit (check one): _____% of Net Specific Dollar Amount $ _____________ .00 0 Remainder of Net Pay Remainder of Net Pay ____ Add new Replace existing account Last 4 digits of the existing account numberEmployer/Company Representative Printed Name: _________________ __ ____ ________ Employer/Company Representative Signature: _____________________________________ Date: ______________ Add new Replace existing account Last 4 digits of the existing account number Add new Replace existing account Last 4 digits of the existing account numberDP0002 /Form Expires /3/102010 123PLEASE PRINT IN BLACK/BLUE INK ONLYEmployee/Worker Signature ____________________________________ ________ _ _______ Date:
EMPLOYEE WEEKLY TIMESHEETMonday Tuesday Wednesday Thursday Friday Saturday Sunday WEEKLY TOTALSTOTAL PAYWeek of: ________________________________ Employee name: Title: Day Start TimeEmployee signature:Supervisor signature: LunchStart LunchEnd End TimeDate:Date: Hourly pay:Supervisor:Vacation/Sick leave RegularHours OvertimehoursTotalHoursWorkedEntered by
At-will employment contracts, The different law exemptions to the general at-will employment rule,The states limiting at-will employment,The advantages and disadvantages of at-will employment for both employers and employees, The reasons an employee may be fired for (including wrongful termination), andThe difference between at-will and right-to-work states.Did you know that in the US you can be legally fired for any reason (or no reason at all) at any time? Employment in most US states is typically ‘at-will’, meaning an employer can fire an employee for anyreason, without any warning. But, at the same time, an employee may resign from work under thesame conditions. However, you can’t be let go for an illegal reason (e.g. reporting a sexual harassmentat work). To help you understand how at-will employment works and your basic rights and limitationsunder this law, we’ve covered everything you need to know about:****Click Here forDetailed InformationRegarding all At-Will StatesAT-WILL EMPLOYMENT
Today’s Date _______________________Dear ______________________________,This letter is to inform you that as of today, ______________, we are terminating youremployment with _______________________________. Your dismissal is at-will,which allows the Company to end the employer-employee relationship without noticeand without reason. This letter serves as a confirmation of the termination meeting youattended this afternoon in my office.If you have any company property in your possession, please return these items, inreasonably good condition. You may leave the items with the HR clerk. Any unreturneditems will be considered stolen property and reported to the appropriate authorities.Your final paycheck is enclosed with this letter. This paycheck includes all hours worked /sales commissions earned and reported as of ______________. Final paycheck shall reflect all full/part time hours and any unused and accrued Vacation/ PTO hours. We wish you all the best going forward.Regards,________________________________________________________ Supervisor Signature Date________________________________________ Company NameAT-WILL TERMINATION LETTER
Page 1 of 5EMPLOYEE EVALUATION FORM EMPLOYER: _____________________________________________ EMPLOYEE: _________________________________________________ DATE: ________________________ DEPARTMENT: __________________________ JOB TITLE: ________________________________________ To take a personal inventory, to pin-point weaknesses and strengths and to outline and agreeupon a practical improvement program. Periodically conducted, these Evaluations will provide ahistory of development and progress. Listed below are a number of traits, abilities and characteristics that are important forsuccess in business. Place an "X" mark on each rating scale, over the descriptive phrasewhich most nearly describes the person being rated. (If this form is being used for self-evaluation, you will be describing yourself.) Carefully evaluate each of the qualities separately. Two common mistakes in rating are: (1) A tendency to rate nearly everyone as "average" on every trait instead of being more critical in judgment. The rater should use the ends of thescale as well as the middle, and (2) The "Halo Effect," i.e., a tendency to rate the sameindividual "excellent" on every trait or "poor" on every trait based on the overall picture onehas of the person being rated. However, each person has strong points and weak points and these should be indicated on the rating scale. ACCURACY is the correctness of work duties performed. (check one) ☐ - ☐ - ☐ - ☐ - ☐ - Comment: ___________________________________________________________________ Instructions Purpose of this Employee Evaluation
Page 2 of 5ALERTNESS is the ability to grasp instructions, to meet challenging conditions and to solve novel or problem situations. (check one) ☐ - ☐ - ☐ - ☐ - ☐ - Comment: ___________________________________________________________________ CREATIVITY istalent for having new ideas, for finding new and better ways of doing things and for being imaginative. (check one) ☐ - ☐ - ☐ - ☐ - ☐ - Comment: ___________________________________________________________________ FRIENDLINESSis the sociability and warmth which an individual imparts in his attitude toward customers, other employees, his supervisor and the persons he may supervise.(check one) ☐ - ☐ - ☐ - ☐ - ☐ - Comment: ___________________________________________________________________ PERSONALITY isan individual's behavior characteristics or his personal suitability for the job. (check one) ☐ - ☐ - ☐ - ☐ - ☐ - Comment: ___________________________________________________________________
Page 3 of 5PERSONAL APPEARANCE is the personal impression an individual makes on others.(Consider cleanliness, grooming, neatness and appropriateness of dress on the job.)appearance. dress. (check one) ☐ - ☐ - ☐ - ☐ - ☐ - Comment: ___________________________________________________________________ PHYSICALFITNESS is the ability to work consistently and with only moderate fatigue. (Consider physical alertness and energy.) (check one) ☐ - ☐ - ☐ - ☐ - ☐ - Comment: ___________________________________________________________________ ATTENDANCE isfaithfulness in coming to work daily and conforming to work hours. (check one) ☐ - ☐ - ☐ - ☐ - ☐ - Comment: ___________________________________________________________________ HOUSEKEEPINGis the orderliness and cleanliness in which an individual keeps his work area. (check one) ☐ - ☐ - ☐ - ☐ - ☐ - Comment: ___________________________________________________________________
Page 4 of 5DEPENDABILITY is the ability to do required jobs well with a minimum of supervision. (checkone) ☐ - ☐ - ☐ - ☐ - ☐ - Comment: ___________________________________________________________________ DRIVE is thedesire to attain goals, to achieve. (check one) ☐ - ☐ - ☐ - ☐ - ☐ - Comment: ___________________________________________________________________ JOBKNOWLEDGE is the information concerning work duties which an individual should know for a satisfactory job performance. (check one) ☐ - ☐ - ☐ - ☐ - ☐ - Comment: ___________________________________________________________________ QUALITY OFWORK is the level of work an individual does in a work day. (check one) ☐ - ☐ - ☐ - ☐ - ☐ - Comment: ___________________________________________________________________
Page 5 of 5 ADDITIONAL COMMENTS STABILITY is the ability to withstand pressure and to remain calm in crisis situations. (check one) ☐ - ☐ - ☐ - ☐ - ☐ - Comment: ___________________________________________________________________COURTESY is the polite attention an individual gives other people. (check one) ☐ - ☐ - ☐ - ☐ - ☐ - Comment: ___________________________________________________________________OVERALL EVALUATION in comparison with other employees with the same length of service on this job. (check one) ☐ - ☐ - ☐ - ☐ - ☐ - Comment: ___________________________________________________________________ ___ __ __ __ __ __ __ ___ __ __ __ _______ __ ___ __ __ __ ___ __ __ __ __ __ __ ___ __ _ ____ __ __ __ ___ ___ __ __ __ __ __ __ ___ __ __ __ __ __ __ __ ___ __ __ __ ___ __ __ __ _ __Rated by: _________________________________________ ___________________________ Signature Date Print Name
EMPLOYEE TIME-OFF REQUEST FORM -Vacation- Jury Duty - To Vote- Approved - RejectedToday’s Date: ________________________Employee’s Name: ________________________Time-Off Request: _____ ☐ Days ☐ Hours Beginning on: ________________________ Ending on: ________________________ - Personal Leave☐- Funeral / Bereavement- Family Reasons☐- Medical Leave- Other: _____________________________________ Employee’s Signature: ________________________ Date: ___________ -- -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -Employer’s Signature: ________________________ Date: ____________Print Name: ________________________ ☐☐☐☐ ☐☐☐☐Reason for Request Employer’s Decision I understand that this request is subject to approval by my employer.
MILEAGE REIMBURSEMENT FORM ______________________________________________________________________ Log 1 ______________________________________________________________________ Log 2 ______________________________________________________________________ Log 3 Date: _____________, 20____ Purpose of Trip: ______________________ Mileage: _____________ Rate: $______ Amount: $_____________ Parking Fees: $_____________ Tolls: $_____________ Other: $_____________ Total: $_____________ Date: _____________, 20____ Purpose of Trip: ______________________ Mileage: _____________ Rate: $______ Amount: $_____________ Parking Fees: $_____________ Tolls: $_____________ Other: $_____________Total: $_____________ Requested From: ______________________ Date: ______________ Requested To: ______________________ Amount Requested: $_____________ Date: _____________, 20____ Purpose of Trip: ______________________ Mileage: _____________ Rate: $______ Amount: $_____________ Parking Fees: $_____________ Tolls: $_____________ Other: $_____________ Total: $_____________ ______________________________________________________________________ I declare under penalty of perjury under the laws of the United States of America that the foregoing is true and correct. Signature: ____________________________ Print Name: ______________________
EMPLOYEE REIMBURSEMENT FORM Approved by (Print): __________________ Reimburse/Cardholder Signature: ______________________ Reimburse/Cardholder Name: _________________________ Prepared by (Print): __________________ Date: ________________ Date: ________________ Name: ___________________________ Title: ____________________________ Department: ______________________ I certify these are valid business expenses. I have reviewed these expenses and I believe they are true andaccurate. DateDescription AmountAuto Exp$ Total$ TotalOffice Exp MealsSee attached receiptsPostage
ACKNOWLEDGEMENT OF RECEIPT OF COMPANY PROPERTY FORMName: Description of Equipment or Property Issued to Employee: Date: By signing this form, I agree to the following: I am responsible for the equipmentor property issued to me; I will use it/them in the manner intended; I will beresponsible for any damage done (excluding normal wear and tear); uponseparation from the Company, I will return the item(s) issued to me in properworking order (excluding normal wear & tear); I will replace any items issued tome that are damaged or lost at my expense; I authorize a payroll deduction tocover the replacement cost of any item issued to me that is not returned forwhatever reason, or is not returned in good working order. Employee Signature Manager Signature Date Date
Change Type: Reason For Change: PAYROLL CHANGE FORM Employee Name: _________________________________ Effective Date: Old Salary:New Salary: __________________________________ Supervisor Signature: Date ____________________________ (changes must be effective the 1st day of a pay period) ____________________________ (if applicable) ____________________________ New Address: __________________________________ (if applicable) New Phone Number: ____________________________ EMERGENCYCONTACT (if applicable) (if applicable) NAME__________________________________ PHONE:_________________________________ ADDRESS:_______________________________name change (certificate attached) address/phone # change promotion/salary increase** other ______________________________________________________ ____________________________________________________________________________________________________________ __________________________________ Employee Signature: Date
1EMPLOYEE WRITE-UP FORMS Table of Contents ••••••Employee Complaint Form – Page 2Employee Counseling Form – Page 4Employee Disciplinary Action Form – Page 5Employee Reprimand Form – Page 7Employee Termination Letter – Page 8Employee Warning Notice – Page 9
2EMPLOYEE COMPLAINT FORM Your Name: ___________________________ Date: _____________ Title:___________________ Phone Number: ___________________ Status:____ Employee ____ Customer ____ Faculty Other (Specify) ________________________ Department: ___________________________ Address: ____________________________________________________ Date of Incident: ______________ Time of Incident: _____________Location of Incident: ___________________________________________Please describe the incident in detail:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________If there are others who have witnessed the incident, please provide theirnames and phone numbers below:____________________________________________________________________________________________________________________________________________________________________________________ Complaint Information
3Is this the first time you have raised this concern about this person? ____ Yes ____ No Do you have any suggestions for resolving the complaint? If so, please explain. ____________________________________________________________________________________________________________________________________________________________________________________ Do you have any additional information or complaints? If so, please explain. ____________________________________________________________________________________________________________________________________________________________________________________ Signature: __________________ Print Name: ________________
4EMPLOYEE COUNSELING FORM _____________________ Employee’s Signature _____________________ Supervisor’s Signature _____________________ Witness’s Signature Employee’s Full Name: ________________Worksite Employer: _________________ _________________Print Name _________________Print Name _________________Print Name ________________Date ________________Date ________________Date ____ Attendance ____ Behavior/Teamwork ____ Inappropriate Conduct ____ Inappropriate Dress ____ Safety Violation ____ Sleeping on the Job ____ Substandard Work ____ Violence ____ Other _________________ Incident Date:_________________ Time of Incident: __________________ __________________________________________________________________________________________________________________________________________________________________________________________________________________Name of Witness(es):______________________________________________________________________Corrective Action:____________________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________________ Counseling Date: __________ Job Title: _______________ Location: _______________ Employee Comments: Describe the nature of the incident (If applicable): This Counseling is being issued because of the following (Select all that apply): This form is intended to help direct the employee onto a successful path in the work place. It isimportant to make immediate and sustained improvement and the failure to do so could result infurther disciplinary action, up to and including termination of employment.
5EMPLOYEE DISCIPLINARY ACTION FORM Violation Date: ________________________ Violation Time: ________________________ Violation Location: ________________________________________________ Employer’s Statement ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ Employee’s Statement ____________________________________________________________________________ ____________________________________________________________________________ Employee: ________________________ Date of Warning: ________________________ Department: _______________________ Supervisor: ________________________ - Attendance ❏ - Carelessness ❏ - Disobedience ❏ - Safety ❏ - Tardiness - Work Quality ❏- Other (explain) _______________________________________________ ________________________________ ________________________________ ________________________________ ________________________________ Warning Type of Violation ❏❏
6________________________________________________________________ ________________________________ Signatures Employer’s/Supervisor’s Signature: ___________________________ Date: _______________ Print Name: ___________________________ Title: ___________________________ I have read this "warning decision". I understand it and have received a copy of the same. Employee’s Signature: ___________________________ Date: _______________ Print Name: ___________________________ Title: ___________________________ The Decision ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ Decision Approved by: _________________ Title: _________________ Date: _____________ Previous Warnings 1st Warning - Date: _________________ Type: ❏ - Verbal ❏ - Written 2nd Warning - Date: _________________ Type: ❏ - Verbal ❏ - Written 3rd Warning - Date: _________________ Type: ❏ - Verbal ❏ - Written Other: ___________________________________________________________________________________________________________________________________________________
7EMPLOYEE REPRIMAND FORM Employee Employee ID # (if any) ____ Administrative Leavew/Pay ____ Sent Home w/Pay ____ None Work Location Date of Occurrence Issuing Supervisor Date of DisciplineAction Given ____ Recommendation for Termination ____ Suspension Without Pay ___ Days ____ Other ____________________________ Description of Corrective Actions to be Taken:________________________________________________________________________________________________________________________________________________ I have read this Notice of Discipline and understand it. ____ Employee refused to sign this form and all attached documentation. ____________________________ ____________________ ________________ Employee’s Signature Print Name Date ____________________________ ____________________ ________________ Supervisor’s Signature Print Name Date ____________________________ ____________________ ________________ Witness’s Signature Print Name Date Violation Statement Place of Violation: _________________ Date of Violation: _________________ Description of Violation: ____________________________________________________________________________________________________________________________________________ Corrective Actions Disciplinary Action
8EMPLOYEE TERMINATION FORM Date: ____________ Name of Terminated Employee: _________________ Address: ___________________________________ ___________________________________________ Dear ___________________, On _______________ (Date), your employment with _______________ will be officially terminated for the following reason: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ I wish you the best in finding new employment. Signature ___________________ Print ___________________
9 Employee’s Name: ___________________________ Date: ______________ Manager/Supervisor’s Name: _________________________ If previous discipline meeting occurred, enter date: _______________ Reasons for Warning: ____ Absenteeism ____ Failure to follow procedure ____ Rudeness ____ Tardiness ____ Failure to meet performance ____ Refusal to work overtime ____ Policy violation ____ Fighting ____ Language ____ Other _______________________ Details of actions that warranted this warning: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ The following immediate and sustained corrective action must be taken by the employee. Failure to do so will result in further disciplinary action up to and including termination: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Note: Your signature on this form means that we have discussed the situation. It doesn’t necessarily mean you agree that the infraction occurred. ____________________________ _____________________ _______________ Employee’s Signature Print Name Date ____________________________ _____________________ _______________ Supervisor’s Signature Print Name Date EMPLOYEE WARNING REPORT FORM
Page 1 of 2 EMPLOYEE INJURY REPORT FORM INJURIES WITNESSES THE INCIDENT PERSON INVOLVED Full Name: _________________ Address: __________________________________ Identification: ☐ Driver’s License No. _____________ ☐ Passport No. _____________ ☐ Other: __________________________ Phone: (____) ____-_____ E-Mail: _________________ Use this form to report accidents, injuries, medical situations, criminal activities, trafficincidents, or student behavior incidents. If possible, a report should be completed within24 hours of the event. Date of Report: _________________, 20____ Date of Incident: _________________, 20____ Time: ____:_____ ☐ AM ☐ PM Location: __________________________________ Describe the Incident: ____________________________________________________ ____________________________________________________________________________________________________________________________________________ Was anyone injured? ☐ Yes ☐ No If yes, describe the injuries: _______________________________________________ ______________________________________________________________________ ______________________________________________________________________ Were there witnesses to the incident? ☐ Yes ☐ No If yes, enter the witnesses’ names and contact info: ____________________________ ____________________________________________________________________________________________________________________________________________
Page 2 of 2 OFFICE USE ONLY POLICE / MEDICAL SERVICES Police Notified? ☐ Yes ☐ No If yes, was a report filed? ☐ Yes ☐ No Was medical treatment provided? ☐ Yes ☐ No ☐ Refused If yes, where was medical treatment provided? ☐ On site ☐ Hospital PERSON FILING REPORT Signature: ________________________ Date: _____________ Print Name: ________________________ Other: _______ Report received by: _________________ Date: _________________, 20____ Follow-up action taken: ___________________________________________________ ____________________________________________________________________________________________________________________________________________ ☐
2SUPERVISOR’S EMPLOYEE INJURY REPORT FORM____________________________________________________________________________________________________________________________________________Name of Injured Person _________________________________________________ Date of Birth _________________ Telephone Number ____________________ Address ______________________________________________________________ City _____________________________ State_______ Zip _____________ (Circle one) Male Female What part of the body was injured? Describe in detail.____________________________________________________________________________What was the nature of the injury? Describe in detail. Describe fully how the accident happened? What was employee doing prior to the event? What equipment, tools being using? ________________________________________________________________________________________________________________________________________________________Names of all witnesses: ____________________________________________________________________________ Date of Event ______________________ Time of Event ___________________________ Exact location of event__________________________________________________________ What caused the event? _________________________________________________________________________________________________________________________________________________________________________________________________________________Were safety regulations in place and used? If not, what was wrong? ___________________________________________________________________________________________________Employee went to doctor/hospital? Doctor’s Name_________________________________________ Hospital Name __________________________________________ Recommended preventive action to take in the future to prevent reoccurrence.__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ ___________ Supervisor Signature Date
QUOTEDateValid UntilQuote #Customer IDSubtotalDiscountSales Tax - -- Customer:Special Notes and InstructionsQuote/Project DescriptionTotal -SignatureNameCo. NameAddressCity, ST ZIP CodePhonePrint NameOnce signed, please Fax, mail or e-mail it to the provided address.Please confirm your acceptance of this quote by signing this documentDateAbove information is not an invoice and only an estimate of services/goods described above.Payment will be collected in prior to provision of services/goods described in this quote.Description Line TotalThank you for your business!
SALES ORDER CountryAddressAttn: PersonPrinted NamePhone Description Company NameCredit Card NumberCity, State/Prov, ZipSignatureName on CardDock DateCountryAddressTax ExemptPayment TermsPreferred Shipping MethodTo ship using your UPS, FedEx or DHL account number, please specify:Exp. (mm/yy)Phone Attn: PersonDate (mm/dd/yy)Company NameThe undersigned is a duly authorized purchasing agent of the above referencedorganization and is authorizing this purchase.City, State/Prov, ZipBilling Zip CodeUnit Cost QuantityUse billing address for shippingTotal Sub Total* $________*Tax and shipping charges will be added to this sub total when applicable.Customer PO #Order Date (mm/dd/yy)Bill To:Ship To:CVV Code _______Total $______
DATE: _______________________ INVOICE # ___________________FROM: TERMS: DUE: ___COD ___Check ___ Net 30___ Credit Card _________________________________ credit card numberExp Date ___/___ CVV Code __________TO: Item Description Quantity Price Amount SubtotalTax Notes : ____________________________________________________BALANCE DUEINVOICE___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
PACKING LIST Company _______________________________ Address ________________________________City, State, Zip ___________________________Phone _______________________________ Email: _______________________________ Order Date Ship Date Customer ______________________________ Address________________________________City____________________________________ State, Zip_______________________________ Order Number Customer PO Number TotalOrdered QuantityOrdered TotalShipped QuantityShipped TotalWeight ProductWeight Ship Method / Acct # Description Shipment Notes Product Number
CREDIT CARD AUTHORIZATION FORMPlease complete all fields. You may cancel this authorization at any time by contacting us. This authorization will remain in effect until cancelled.CreditCardInformation______________________________________________Customer Signature______________________________________________DateCard Type: MasterCard VISA Discover AMEX Other ___________________________________________Cardholder Name (as shown on card): ______________________________________________________________Card Number: __________________________________________________________________________________________Expiration Date (mm/yy): ___________________________________________ CVV Code___________________Cardholder ZIP Code (from credit card billing address): ___________________________________________I, _______________________________, authorize __________________________________ to charge my credit card above for agreed upon purchases. I understand that my information will be saved to file for future transactions on my account.☐☐ ☐ ☐☐ INVOICE #________________________ $ ________________Square-up - Leading Credit Card Processing Company - Click Here
NEW CUSTOMERSET-UP FORMName:Address:Address:City:State:Phone:Email:Website:Taxable:Purchasing:Ph:Acct Payable:Ph:Engineering:Ph:Today's Date:Zip:Fx:Customer Status Type: OEM1st Order accepted with Credit Card:Credit Card Type: VisaCard Number:Name on Card:Billing Address:X:X:X:*Resale/ExemptionCertificateRequiredFx:Fx:Fx:Exp. Date:Card CCV(back card):Name:Address:Address:City:State:Phone:Email:Website: Ship Via/Carrier:Email:Email:Email:Account #:Distributor: OS Rep:IS Rep:Notes:Zip:Fx:CONTACTS:BILLING INFORMATION SHIPPING INFORMATION For Internal use only:Yes No*MastercardYesEnd UserAmexNoResellerCollectConv DistUPSOtherOther:Fed Ex
IF vendor is not CORP and was paid $600+ Vendor Name NEW VENDOR SET-UP FORM Address Line 1Address Line 2Phone | FaxEmail Separate checks? YES NO INTERNAL USE ONLY ORGANIZATION TYPE Corporation LLC W-9 FORM ATTACHED Individual / Sole Proprietor Partnership / Limited Partnership Accept purchasing card? e.g, Visa, MC, etc. BANKING INFORMATION ACCOUNT NO. ROUTING NO. Joint VentureNon Profit VENDOR INFORMATION PHONE VENDOR ADDRESS TAX EXEMPT? Y or N POINT OF CONTACT NAME FAX REQUESTOR / VENDOR’S NAME VENDOR ID PAYMENT ADDRESS if different from address above ALTERNATE NAME if applicable / (doing business as) TITLE COMPANY / FIRM NAME as shown on Federal Tax Return SIGNATURE VENDOR EMAIL DATE RECEIVED DATE REQUESTED / SENT VENDOR ID. if applicable TAX ID NUMBER FEIN OR SSN DATE PAYMENT PROCESSED YES NO Checking
NAMEPHONEADDRESSEMAIL ADDRESSCOMPANY NAMESHIPPING TERMSNAMEPHONEADDRESSEMAIL ADDRESSCOMPANY NAMESHIPPING METHODP.O. NUMBER DATEDELIVERY DATEVENDORCodeProduct DescriptionNote:Payment shall be 30 days upon receipt of the items above.QuantityCUSTOMERSubtotal ($)Discount (%)Sales Tax (%)Other Cost ($)Shipping&Handling($) Total Amount ($)Unit Price AmountPURCHASEORDER
6 City, state, and ZIP code7 List account number(s) here (optional)2 Business name/disregarded entity name, if different from aboveCat. No. 10231XForm (Rev. October 2018)Department of the Treasury Internal Revenue Service Go to www.irs.gov/FormW9 1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank.Form 3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the 4 Exemptions (codes apply only tofollowing seven boxes. certain entities, not individuals; see instructions on page 3): Individual/sole proprietor or C Corporation S Corporation Partnership Trust/estate single-member LLCExempt payee code (if any) imited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) Note: Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check Exemption from FATCA reporting LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single-member LLC that code (if any)i s disregarded from the owner should check the appropriate box for the tax classification of its own Other (see instructions) (Applies to accounts maintained outside the U.S.)5 Address (number, street, and apt. or suite no.) See instructions.Requester’s name and address (optional) (Rev. 10-2018)W-9Request for Taxpayer Identification Number and CertificationSection references are to the Internal Revenue Code unless otherwisenoted.Future developments. For the latest information about developments related to Form W-9 and its instructions, such as legislation enacted after they were published, go to www.irs.gov/FormW9.An individual or entity (Form W-9 requester) who is required to file aninformation return with the IRS must obtain your correct taxpayeridentification number (TIN) which may be your social security number(SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number(EIN), to report on an information return the amount paid to you, or otheramount reportable on an information return. Examples of informationreturns include, but are not limited to, the following.• Form 1099-INT (interest earned or paid)Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoidbackup withholding. For individuals, this is generally your social security number (SSN). However, for aresident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For otherentities, it is your employer identification number (EIN). If you do not have a number, see How to get aTIN, later.Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and Number To Give the Requester for guidelines on whose number to enter.• Form 1099-DIV (dividends, including those from stocks or mutualfunds)• Form 1099-MISC (various types of income, prizes, awards, or gross proceeds)• Form 1099-B (stock or mutual fund sales and certain other transactions by brokers)• Form 1099-S (proceeds from real estate transactions)• Form 1099-K (merchant card and third party network transactions)• Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tuition)• Form 1099-C (canceled debt)• Form 1099-A (acquisition or abandonment of secured property)UseForm W-9 only if you are a U.S. person (includingaresidentalien),toprovide your correct TIN. What is backupwithholding, Under penalties of perjury, I certify that:1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and3. I am a U.S. citizen or other U.S. person (defined below); and4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later.for instructions and the latest information.–– –If you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See later.orGive Form to therequester. Do notsend to the IRS.Print or type. Specific Instructions Seeon page 3.Signature ofU.S. personDate Social security numberEmployer identification number SignHerePart IPart II CertificationTaxpayer Identification Number (TIN)W-9General InstructionsPurpose of Form
Form W-9 (Rev. 10-2018)Page 2 By signing the filled-out form, you: 1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued),2. Certify that you are not subject to backup withholding, or3. Claim exemption from backup withholding if you are a U.S. exempt payee. If applicable, you are also certifying that as a U.S. person, your allocable share of any partnership income from a U.S. trade or business is not subject to the withholding tax on foreign partners' share of effectively connected income, and 4. Certify that FATCA code(s) entered on this form (if any) indicating that you are exempt from the FATCA reporting, is correct. See What is FATCA reporting, later, for further information.Note: If you are a U.S. person and a requester gives you a form other than Form W-9 to request your TIN, you must use the requester’s form if it is substantially similar to this Form W-9.Definition of a U.S. person. For federal tax purposes, you are considered a U.S. person if you are:• An individual who is a U.S. citizen or U.S. resident alien;• A partnership, corporation, company, or association created or organized in the United States or under the laws of the United States;• An estate (other than a foreign estate); or• A domestic trust (as defined in Regulations section 301.7701-7).Special rules for partnerships. Partnerships that conduct a trade or business in the United States are generally required to pay a withholding tax under section 1446 on any foreign partners’ share of effectively connected taxable income from such business. Further, in certain cases where a Form W-9 has not been received, the rules under section 1446 require a partnership to presume that a partner is a foreign person, and pay the section 1446 withholding tax. Therefore, if you are a U.S. person that is a partner in a partnership conducting a trade or business in the United States, provide Form W-9 to the partnership to establish your U.S. status and avoid section 1446 withholding on your share of partnership income.In the cases below, the following person must give Form W-9 to the partnership for purposes of establishing its U.S. status and avoiding withholding on its allocable share of net income from the partnership conducting a trade or business in the United States.• In the case of a disregarded entity with a U.S. owner, the U.S. owner of the disregarded entity and not the entity;• In the case of a grantor trust with a U.S. grantor or other U.S. owner, generally, the U.S. grantor or other U.S. owner of the grantor trust and not the trust; and• In the case of a U.S. trust (other than a grantor trust), the U.S. trust (other than a grantor trust) and not the beneficiaries of the trust.Foreign person. If you are a foreign person or the U.S. branch of a foreign bank that has elected to be treated as a U.S. person, do not use Form W-9. Instead, use the appropriate Form W-8 or Form 8233 (see Pub. 515, Withholding of Tax on Nonresident Aliens and Foreign Entities).Nonresident alien who becomes a resident alien. Generally, only a nonresident alien individual may use the terms of a tax treaty to reduce or eliminate U.S. tax on certain types of income. However, most tax treaties contain a provision known as a “saving clause.” Exceptions specified in the saving clause may permit an exemption from tax to continue for certain types of income even after the payee has otherwise become a U.S. resident alien for tax purposes.If you are a U.S. resident alien who is relying on an exception contained in the saving clause of a tax treaty to claim an exemption from U.S. tax on certain types of income, you must attach a statement to Form W-9 that specifies the following five items.1. The treaty country. Generally, this must be the same treaty under which you claimed exemption from tax as a nonresident alien.2. The treaty article addressing the income.3. The article number (or location) in the tax treaty that contains the saving clause and its exceptions.4. The type and amount of income that qualifies for the exemption from tax.5. Sufficient facts to justify the exemption from tax under the terms of the treaty article.The Foreign Account Tax Compliance Act (FATCA) requires aparticipating foreign financial institution to report all United Statesaccount holders that are specified United States persons. Certainpayees are exempt from FATCA reporting. See reporting code, later, and the Instructions for the Requester of FormW-9 for more information.Failure to furnish TIN. If you fail to furnish your correct TIN to arequester, you are subject to a penalty of $50 for each such failureunless your failure is due to reasonable cause and not to willful neglect.Civil penalty for false information with respect to withholding. If you make a false statement with no reasonable basis that results in no backup withholding, you are subject to a $500 penalty.Example. Article 20 of the U.S.-China income tax treaty allows an exemption from tax for scholarship income received by a Chinesestudent temporarily present in the United States. Under U.S. law, thisstudent will become a resident alien for tax purposes if his or her stay inthe United States exceeds 5 calendar years. However, paragraph 2 ofthe first Protocol to the U.S.-China treaty (dated April 30, 1984) allowsthe provisions of Article 20 to continue to apply even after the Chinesestudent becomes a resident alien of the United States. A Chinese student who qualifies for this exception (under paragraph 2 of the firstprotocol) and is relying on this exception to claim an exemption from taxon his or her scholarship or fellowship income would attach to Form W-9 a statement that includes the information described above tosupport that exemption.If you are a nonresident alien or a foreign entity, give the requester the appropriate completed Form W-8 or Form 8233.What is backup withholding? Persons making certain payments to youmust under certain conditions withhold and pay to the IRS 24% of suchpayments. This is called “backup withholding.” Payments that may besubject to backup withholding include interest, tax-exempt interest,dividends, broker and barter exchange transactions, rents, royalties,nonemployee pay, payments made in settlement of payment card andthird party network transactions, and certain payments from fishing boatoperators. Real estate transactions are not subject to backup withholding.You will not be subject to backup withholding on payments you receive if you give the requester your correct TIN, make the proper certifications, and report all your taxable interest and dividends on your tax return.Payments you receive will be subject to backup withholding if: 1. You do not furnish your TIN to the requester,2. You do not certify your TIN when required (see the instructions for Part II for details),3. The IRS tells the requester that you furnished an incorrect TIN,4. The IRS tells you that you are subject to backup withholding because you did not report all your interest and dividends on your tax return (for reportable interest and dividends only), or5. You do not certify to the requester that you are not subject to backup withholding under 4 above (for reportable interest and dividend accounts opened after 1983 only).Certain payees and payments are exempt from backup withholding. See Exempt payee code, later, and the separate Instructions for the Requester of Form W-9 for more information.Also see Special rules for partnerships, earlier.You must provide updated information to any person to whom youclaimed to be an exempt payee if you are no longer an exempt payeeand anticipate receiving reportable payments in the future from thisperson. For example, you may need to provide updated information ifyou are a C corporation that elects to be an S corporation, or if you nolonger are tax exempt. In addition, you must furnish a new Form W-9 ifthe name or TIN changes for the account; for example, if the grantor of agrantor trust dies.Exemption from FATCA PenaltiesBackup WithholdingUpdating Your InformationWhat is FATCA Reporting?
Form W-9 (Rev. 10-2018)Page Line 1Line 2Line 3Line 4, Exemptions3 IF the entity/person on line 1 isa(n) . . .THEN check the box for . . .If you have a business name, trade name, DBA name, or disregardedentity name, you may enter it on line 2.Criminal penalty for falsifying information. Willfully falsifyingcertifications or affirmations may subject you to criminal penaltiesincluding fines and/or imprisonment.Misuse of TINs. If the requester discloses or uses TINs in violation of federal law, the requester may be subject to civil and criminal penalties.Check the appropriate box on line 3 for the U.S. federal tax classification of the person whose name is entered on line 1. Check onlyone box on line 3.You must enter one of the following on this line; do not leave this lineblank. The name should match the name on your tax return.If this Form W-9 is for a joint account (other than an account maintained by a foreign financial institution (FFI)), list first, and then circle, the name of the person or entity whose number you entered in Part I of Form W-9. If you are providing Form W-9 to an FFI to document a joint account, each holder of the account that is a U.S. person must provide a Form W-9.a. Individual. Generally, enter the name shown on your tax return. If you have changed your last name without informing the Social Security Administration (SSA) of the name change, enter your first name, the last name as shown on your social security card, and your new last name. Note: ITIN applicant: Enter your individual name as it was entered on your Form W-7 application, line 1a. This should also be the same as the name you entered on the Form 1040/1040A/1040EZ you filed with your application.b. Sole proprietor or single-member LLC. Enter your individual name as shown on your 1040/1040A/1040EZ on line 1. You may enter your business, trade, or “doing business as” (DBA) name on line 2.c. Partnership, LLC that is not a single-member LLC, C corporation, or S corporation. Enter the entity's name as shown on the entity's tax return on line 1 and any business, trade, or DBA name on line 2.d. Other entities. Enter your name as shown on required U.S. federal tax documents on line 1. This name should match the name shown on the charter or other legal document creating the entity. You may enter any business, trade, or DBA name on line 2.e. Disregarded entity. For U.S. federal tax purposes, an entity that is disregarded as an entity separate from its owner is treated as a “disregarded entity.” See Regulations section 301.7701-2(c)(2)(iii). Enter the owner's name on line 1. The name of the entity entered on line 1 should never be a disregarded entity. The name on line 1 should be the name shown on the income tax return on which the income should be reported. For example, if a foreign LLC that is treated as a disregarded entity for U.S. federal tax purposes has a single owner that is a U.S. person, the U.S. owner's name is required to be provided on line 1. If the direct owner of the entity is also a disregarded entity, enter the first owner that is not disregarded for federal tax purposes. Enter the disregarded entity's name on line 2, “Business name/disregarded entity name.” If the owner of the disregarded entity is a foreign person, the owner must complete an appropriate Form W-8 instead of a Form W-9. This is the case even if the foreign person has a U.S. TIN. • CorporationCorporation• Individual Individual/sole proprietor or single-• Sole proprietorship, or member LLC• Single-member limited liability company (LLC) owned by an individual and disregarded for U.S. federal tax purposes.• LLC treated as a partnership for Limited liability company and enter U.S. federal tax purposes, the appropriate tax classification. • LLC that has filed Form 8832 or (P= Partnership; C= C corporation; 2553 to be taxed as a corporation, or S= S corporation)or • LLC that is disregarded as an entity separate from its owner but the owner is another LLC that is not disregarded for U.S. federal tax purposes.• PartnershipPartnership• Trust/estateTrust/estateIf you are exempt from backup withholding and/or FATCA reporting, enterin the appropriate space on line 4 any code(s) that may apply to you.Exempt payee code.• Generally, individuals (including sole proprietors) are not exempt frombackup withholding.• Except as provided below, corporations are exempt from backup withholding for certain payments, including interest and dividends.• Corporations are not exempt from backup withholding for payments made in settlement of payment card or third party network transactions.• Corporations are not exempt from backup withholding with respect to attorneys’ fees or gross proceeds paid to attorneys, and corporations that provide medical or health care services are not exempt with respect to payments reportable on Form 1099-MISC.The following codes identify payees that are exempt from backup withholding. Enter the appropriate code in the space in line 4.1—An organization exempt from tax under section 501(a), any IRA, or a custodial account under section 403(b)(7) if the account satisfies the requirements of section 401(f)(2)2—The United States or any of its agencies or instrumentalities3—A state, the District of Columbia, a U.S. commonwealth or possession, or any of their political subdivisions or instrumentalities4—A foreign government or any of its political subdivisions, agencies, or instrumentalities 5—A corporation6—A dealer in securities or commodities required to register in the United States, the District of Columbia, or a U.S. commonwealth or possession 7—A futures commission merchant registered with the Commodity Futures Trading Commission8—A real estate investment trust9—An entity registered at all times during the tax year under the Investment Company Act of 194010—A common trust fund operated by a bank under section 584(a)11—A financial institution12—A middleman known in the investment community as a nominee or custodian13—A trust exempt from tax under section 664 or described in section 4947Specific Instructions
Form W-9 (Rev. 10-2018)Page Line 5Line 64 The following chart shows types of payments that may be exempt from backup withholding. The chart applies to the exempt payees listedabove, 1 through 13.Interest and dividend paymentsAll exempt payees except for 7Broker transactionsExempt payees 1 through 4 and 6 through 11 and all C corporations. S corporations must not enter an exempt payee code because they are exempt only for sales of noncovered securities acquired prior to 2012. Barter exchange transactions and Exempt payees 1 through 4patronage dividendsPayments over $600 required to be Generally, exempt payees reported and direct sales over 1 through 52$5,0001Payments made in settlement of Exempt payees 1 through 4payment card or third party network transactions 1 See Form 1099-MISC, Miscellaneous Income, and its instructions.2 However, the following payments made to a corporation and reportable on Form 1099-MISC are not exempt from backup withholding: medical and health care payments, attorneys’ fees, gross proceeds paid to an attorney reportable under section 6045(f), and payments for services paid by a federal executive agency.Exemption from FATCA reporting code. The following codes identify payees that are exempt from reporting under FATCA. These codes apply to persons submitting this form for accounts maintained outside of the United States by certain foreign financial institutions. Therefore, if you are only submitting this form for an account you hold in the United States, you may leave this field blank. Consult with the person requesting this form if you are uncertain if the financial institution is subject to these requirements. A requester may indicate that a code is not required by providing you with a Form W-9 with “Not Applicable” (or any similar indication) written or printed on the line for a FATCA exemption code.A—An organization exempt from tax under section 501(a) or any individual retirement plan as defined in section 7701(a)(37)B—The United States or any of its agencies or instrumentalitiesC—A state, the District of Columbia, a U.S. commonwealth or possession, or any of their political subdivisions or instrumentalitiesD—A corporation the stock of which is regularly traded on one or more established securities markets, as described in Regulations section 1.1472-1(c)(1)(i)E—A corporation that is a member of the same expanded affiliated group as a corporation described in Regulations section 1.1472-1(c)(1)(i)F—A dealer in securities, commodities, or derivative financial instruments (including notional principal contracts, futures, forwards, and options) that is registered as such under the laws of the United States or any stateG—A real estate investment trustH—A regulated investment company as defined in section 851 or an entity registered at all times during the tax year under the Investment Company Act of 1940I—A common trust fund as defined in section 584(a)J—A bank as defined in section 581K—A brokerL—A trust exempt from tax under section 664 or described in section 4947(a)(1)Enter your city, state, and ZIP code.To establish to the withholding agent that you are a U.S. person, orresident alien, sign Form W-9. You may be requested to sign by thewithholding agent even if item 1, 4, or 5 below indicates otherwise.For a joint account, only the person whose TIN is shown in Part I should sign (when required). In the case of a disregarded entity, the person identified on line 1 must sign. Exempt payees, see code, earlier.Signature requirements. Complete the certification as indicatedin items 1 through 5 below.M—A tax exempt trust under a section 403(b) plan or section 457(g) planNote: You may wish to consult with the financial institution requesting this form to determine whether the FATCA code and/or exempt payee code should be completed.Enter your address (number, street, and apartment or suite number).This is where the requester of this Form W-9 will mail your informationreturns. If this address differs from the one the requester already has onfile, write NEW at the top. If a new address is provided, there is still achance the old address will be used until the payor changes youraddress in their records.Enter your TIN in the appropriate box. If you are a resident alien andyou do not have and are not eligible to get an SSN, your TIN is your IRSindividual taxpayer identification number (ITIN). Enter it in the socialsecurity number box. If you do not have an ITIN, see How to get a TINbelow.If you are a sole proprietor and you have an EIN, you may enter either your SSN or EIN. If you are a single-member LLC that is disregarded as an entity separate from its owner, enter the owner’s SSN (or EIN, if the owner has one). Do not enter the disregarded entity’s EIN. If the LLC is classified as a corporation or partnership, enter the entity’s EIN.Note: See What Name and Number To Give the Requester, later, for further clarification of name and TIN combinations.How to get a TIN. If you do not have a TIN, apply for one immediately. To apply for an SSN, get Form SS-5, Application for a Social Security Card, from your local SSA office or get this form online at www.SSA.gov. You may also get this form by calling 1-800-772-1213. Use Form W-7, Application for IRS Individual Taxpayer Identification Number, to apply for an ITIN, or Form SS-4, Application for Employer Identification Number, to apply for an EIN. You can apply for an EIN online by accessing the IRS website at www.irs.gov/Businesses and clicking on Employer Identification Number (EIN) under Starting a Business. Go to www.irs.gov/Forms to view, download, or print Form W-7 and/or Form SS-4. Or, you can go to www.irs.gov/OrderForms to place an order and have Form W-7 and/or SS-4 mailed to you within 10 business days.If you are asked to complete Form W-9 but do not have a TIN, apply for a TIN and write “Applied For” in the space for the TIN, sign and date the form, and give it to the requester. For interest and dividend payments, and certain payments made with respect to readily tradable instruments, generally you will have 60 days to get a TIN and give it to the requester before you are subject to backup withholding on payments. The 60-day rule does not apply to other types of payments. You will be subject to backup withholding on all such payments until you provide your TIN to the requester.Note: Entering “Applied For” means that you have already applied for a TIN or that you intend to apply for one soon.Caution: A disregarded U.S. entity that has a foreign owner must use the appropriate Form W-8.IF the payment is for . . .THEN the payment is exemptfor . . .Exemptpayee Part II. CertificationPart I. Taxpayer Identification Number (TIN)Request for Taxpayer ID - IRS Form W-9 - Click Here
Form W-9 (Rev. 10-2018)8. Disregarded entity not owned by an individual9. A valid trust, estate, or pension trust10. Corporation or LLC electing corporate status on Form 8832 or Form 255311. Association, club, religious, charitable, educational, or other tax-exempt organization12. Partnership or multi-member LLC13. A broker or registered nominee1. Individual2. Two or more individuals (joint account) other than an account maintained by an FFI3. Two or more U.S. persons (joint account maintained by an FFI)4. Custodial account of a minor (Uniform Gift to Minors Act)5. a. The usual revocable savings trust (grantor is also trustee) b. So-called trust account that is not a legal or valid trust under state law6. Sole proprietorship or disregarded entity owned by an individual7. Grantor trust filing under Optional Form 1099 Filing Method 1 (see Regulations section 1.671-4(b)(2)(i)(A))The owner3The grantor*The ownerLegal entity4The corporationThe organizationThe partnershipThe broker or nomineeThe individualThe actual owner of the account or, if combined funds, the first individual on the account1Each holder of the account The minor2 The grantor-trustee1The actual owner114. Account with the Department of Agriculture in the name of a public entity (such as a state or local government, school district, or prison) that receives agricultural program payments15. Grantor trust filing under the Form 1041 Filing Method or the Optional Form 1099 Filing Method 2 (see Regulations section 1.671-4(b)(2)(i)(B))The trustThe public entityPage 5 For this type of account:For this type of account: Give name and EIN of:Give name and SSN of:1. Interest, dividend, and barter exchange accounts opened before 1984 and broker accounts considered active during 1983.You must give your correct TIN, but you do not have to sign thecertification.2. Interest, dividend, broker, and barter exchange accounts opened after 1983 and broker accounts considered inactive during 1983. 3. Real estate transactions. 4. Other payments. 5. Mortgage interest paid by you, acquisition or abandonment of secured property, cancellation of debt, qualified tuition program payments (under section 529), ABLE accounts (under section 529A), IRA, Coverdell ESA, Archer MSA or HSA contributions or distributions, and pension distributions. For this type of account: Give name and EIN of:You must give yourcorrect TIN, but you do not have to sign the certification.You must sign the certification or backupwithholding will apply. If you are subject to backup withholdingand you are merely providing your correct TIN to the requester,you must cross out item 2 in thecertification before signing theform.You must sign the certification.You may cross out item 2 of the certification.You must give your correct TIN, but youdo not have to sign the certification unless you have beennotified that you have previously given an incorrect TIN. “Other payments” include payments made in the course of the requester’s trade or business for rents, royalties, goods (other than bills for merchandise), medical and health care services (including payments to corporations), payments to a nonemployee for services, payments made in settlement of payment card and third party network transactions, payments to certain fishing boat crewmembers and fishermen, and gross proceeds paid to attorneys(including payments to corporations). Identity theft occurs when someone uses your personal information such as your name, SSN, or other identifying information, without yourpermission, to commit fraud or other crimes. An identity thief may useyour SSN to get a job or may file a tax return using your SSN to receivea refund.To reduce your risk:• Protect your SSN,• Ensure your employer is protecting your SSN, and• Be careful when choosing a tax preparer.If your tax records are affected by identity theft and you receive a notice from the IRS, respond right away to the name and phone number printed on the IRS notice or letter.If your tax records are not currently affected by identity theft but you think you are at risk due to a lost or stolen purse or wallet, questionable credit card activity or credit report, contact the IRS Identity Theft Hotline at 1-800-908-4490 or submit Form 14039.For more information, see Pub. 5027, Identity Theft Information for Taxpayers.Victims of identity theft who are experiencing economic harm or a systemic problem, or are seeking help in resolving tax problems that have not been resolved through normal channels, may be eligible for Taxpayer Advocate Service (TAS) assistance. You can reach TAS by calling the TAS toll-free case intake line at 1-877-777-4778 or TTY/TDD 1-800-829-4059.Protect yourself from suspicious emails or phishing schemes. Phishing is the creation and use of email and websites designed to mimic legitimate business emails and websites. The most common act is sending an email to a user falsely claiming to be an established legitimate enterprise in an attempt to scam the user into surrendering private information that will be used for identity theft.1 List first and circle the name of the person whose number you furnish. If only one person on a joint account has an SSN, that person’s number must be furnished.2 Circle the minor’s name and furnish the minor’s SSN.3 You must show your individual name and you may also enter your business or DBA name on the “Business name/disregarded entity” name line. You may use either your SSN or EIN (if you have one), but the IRS encourages you to use your SSN.4 List first and circle the name of the trust, estate, or pension trust. (Do not furnish the TIN of the personal representative or trustee unless the legal entity itself is not designated in the account title.) Also see Special rules for partnerships, earlier.*Note: The grantor also must provide a Form W-9 to trustee of trust.Note: If no name is circled when more than one name is listed, the number will be considered to be that of the first name listed.What Name and Number To Give the RequesterSecure Your Tax Records From Identity Theft
Form W-9 (Rev. 10-2018)Page 6 The IRS does not initiate contacts with taxpayers via emails. Also, theIRS does not request personal detailed information through email or ask taxpayers for the PIN numbers, passwords, or similar secret accessinformation for their credit card, bank, or other financial accounts.If you receive an unsolicited email claiming to be from the IRS, forward this message to phishing@irs.gov. You may also report misuse of the IRS name, logo, or other IRS property to the Treasury Inspector General for Tax Administration (TIGTA) at 1-800-366-4484. You can forward suspicious emails to the Federal Trade Commission at spam@uce.gov or report them at www.ftc.gov/complaint. You can contact the FTC at www.ftc.gov/idtheft or 877-IDTHEFT (877-438-4338). If you have been the victim of identity theft, see www.IdentityTheft.gov and Pub. 5027.Visit www.irs.gov/IdentityTheft to learn more about identity theft and how to reduce your risk.Section 6109 of the Internal Revenue Code requires you to provide yourcorrect TIN to persons (including federal agencies) who are required tofile information returns with the IRS to report interest, dividends, orcertain other income paid to you; mortgage interest you paid; theacquisition or abandonment of secured property; the cancellation ofdebt; or contributions you made to an IRA, Archer MSA, or HSA. Theperson collecting this form uses the information on the form to fileinformation returns with the IRS, reporting the above information. Routine uses of this information include giving it to the Department ofJustice for civil and criminal litigation and to cities, states, the District ofColumbia, and U.S. commonwealths and possessions for use inadministering their laws. The information also may be disclosed to othercountries under a treaty, to federal and state agencies to enforce civiland criminal laws, or to federal law enforcement and intelligenceagencies to combat terrorism. You must provide your TIN whether or not you are required to file a tax return. Under section 3406, payers must generally withhold a percentage of taxable interest, dividend, andcertain other payments to a payee who does not give a TIN to the payer.Certain penalties may also apply for providing false or fraudulentinformation.Privacy Act Notice