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Name:

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Rate:

Phone/Fax:

Middle Name:

Extra Rate:

Username:

Last Name:

Password:

Suffix:

Email:

Street:

Carallowance:

City:

State:

Zip_code:

Ext:

Health Amount:

Department:

VC Program:

Commission/Other:

Project:

VC Code:

Bonus:

Task:

VC Password:

Advance:

Over Night:

Yes No

Pay Advance:

History:

DOB:

Meal:

Direct Deposit:

Yes No

Bank for Deposit:

Acct. to Deposit:

Hours/Day:

Acrrue Sick/Vac:

Yes No

Calendar:

Indep. Contr/Per.:

Location

Manager

Prof. Serv.:

Yes No

Title:

L/M

Prof. Waiver:

Yes No

Hours on Month

Hours Accrual

Salary:

Yes No

Vacation:

Salary Amount:

Sick:

Child:

Yes No

Active:

Active Inactive

Tips:

Accrued Vac YTD:

In/Out:

Accrued Sick YTD:

Information for Income Tax Withholding

Avilable Vac.:

Employee's Status:

Tax Exemption: Yes No

Avilable Sick:

Allowance Claim:

Aditional Amount:

Other Income:

Dependents:

Exemptions:

Other Deductions:

Personal Exemption:

Information for Income Tax Withholding

FOR W2 ONLY
Dep. Care Ben:		Code D:		Code E:		Code F:
Code G:		Code H:		Sec. 457:		Code W:
N Sec. 457:		Code Q:		Code C:		Code V:
Code Y:		Code AA:		Code BB:		Code DD:
Code FF:		Statutory Emp:		R. Plan:		3 P. Ind/Amt:
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