Employee Information Submission

Please fill out the information below.

Contact your manager if you have any questions. Refer to Federal and State W-4 for tax withholdings.

Tax Forms below are ONLY for reference, you do not need to fill them out here.

Company Name

First Name

Last Name

Gender

SSN

Date of Birth

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Federal Status

Step 2 Multiple Jobs/Spouse Works

Refer to W-4

Step 3 Claim Dependent

Refer to W-4 to calculate this amount

Step 4a Other Income (not from jobs)

If you want tax withheld for other income you expect this year that won’t have withholding, enter the amount of other income here. This may include interest, dividends, and retirement income

Step 4b 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

Step 4c Extra Withholdings

Enter any additional tax you want withheld each pay period

Hawaii State Status

Hawaii State Allowances

Start Date

Pay Type

Pay Amount

Department

Job Title

Bank Routing Number

Bank Account Number

Bank Account Type

Federal W-4

Hawaii W-4