Employee Maintenance Form

Termination Date:

Hire Date:

Social Security #:

Name:

Address:

City:

State:

Zip Code:

Phone Number:

Birth Date:

Worker's Comp Code:

Personal Email Address:

School District Name:

School District Number (####):

Additional Federal Exemptions:

Additional State Exemptions:

Employment city:

Miscellaneous Deductions:

Direct Deposit:

Yes No

Pay Frequency:

Weekly Bi-Weekly Semi-Monthly Monthly

Employee Type:

Hourly Salary

Filing Status:

Single Married

Overtime paid at 1.5 * Rate:

Yes No

If No, please explain:

Hourly Rates:

Rate 1

Rate 2

Rate 3

Salary and hours per payroll period:

Salary

Hours