New Hire (Only if unable to use Onboarding)

New Hire

"*" indicates required fields

Name*

First Last

Home Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone

Email*

Gender*

SSN*

Date of Birth*

MM slash DD slash YYYY

Actual Start Date

MM slash DD slash YYYY

Rate of Pay*

Direct Deposit*

Yes

W4 Filing Status*

Single

Married

Married, but withhold at higher Single rate

W4 Deductions Claimed*

Work Status*

Part Time Less than 18 hours per week (Office use: NBE, Meas, PTH, No PTO)

Part Time 18 to 29 hours per week (Office use: NBE, Meas, PTH, P-PTO)

Part Time 30 to 34 hours per week (Office use: BE, Meas, PTH, P-PTO)

Full Time 35 or more hours per week (Office use: BE; Meas, FTH or FTS, C-PTP)

Is This Employee a Rehire?*

Yes

Employment Location*

Call Us: (802) 864-5155

32 San Remo Drive
South Burlington, VT
05403

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