Employee Information Sheet Page 2
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1
2Pay Frequency
Payday details
Date(s) or day(s) employees paid _______________________
Every Week
st
th
(for example, the 1
and 15
of the month)
Every Other Week
Twice a Month
Period Covered _____________________________________
Every Month
st
th
(for example, Paycheck on the 1
covers the 16
to the end of the prior
Other _______
month)
Payroll Deductions
Select the voluntary deductions that apply and enter the $ or % amount to be deducted from each
paycheck.
Deduction
$ Amount or
Deduction
$ Amount or
% of Gross
% of Gross
Medical
403(b)
Vision
Simple IRA
Dental
SARSEP
Pre-tax medical
Medical expense FSA
Pre-tax vision
Dependent care FSA
Pre-tax dental
Loan Repayment
401(k)
Cash Advance
Repayment
Simple 401(k)
Other __________
Is this employee subject to wage garnishments, such as a federal tax or child support garnishment?
Yes
If so, attach copies of all garnishment orders
No
Sick and Vacation
If this employee earns paid time off, complete the section below; otherwise, leave blank.
Sick Pay
Vacation Pay
No. of Hours Earned Per Year
________
No. of Hours Earned Per Year
________
Max. hours accrued per year (if any)
________
Max. hours accrued per year (if any)
________
Current Balance ________
Current Balance ________
Hours are accrued:
Hours are accrued:
As a lump sum at the beginning of year
As a lump sum at the beginning of year
Each pay period
Each pay period
Each hour worked
Each hour worked
Notes
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Parent category: Business