New Employee Input Form:
Fill out form, then print and fax to (405)360-9202
Company Name:
Prepared By:
Email Address:
Input Date:
Employee Information:
SSN:
Hire Date:
Last Name:
First, Middle Initial:
Address:
City/State/Zip:
Type of pay:
Salary
Hourly
Rate of Pay:
Tax Table:
Weekly
Bi-Weekly
Semi-Montly
Monthly
Marital
Status:
Married
Single
Dependants:
Department:
Phone Number:
Terminated on:
Date of Birth:
Voluntary Deductions:
Deduction (name and amount):
Deduction (name and amount):
Deduction (name and amount):
Deduction (name and amount):
Deduction (name and amount):
Deduction (name and amount):
Exceptions to Federal and/or State Withholding:
Federal Withholding:
Additional (A)
Exempt (E)
Fixed (F)
Amount:
State Withholding:
Additional (A)
Exempt (E)
Fixed (F)
Amount:
401K / Simple IRA:
Employee Contribution:
Fixed ($)
Percent (%)
Amount:
Employer Match:
Fixed ($)
Percent (%)
Amount:
Direct Deposit Information:
ABA Routing #:
Bank Account #:
Checking
Savings