New Hire Start Info

Please submit this form at least 48 hours before employee starts, if possible!

Subject

ENTER "NEW HIRE START" IN SUBJECT LINE BELOW.

Name

First Name

Last Name

Mobile Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Social Security Number

Confirm Social Security Number

Date of Birth

YYYY

Start Date

YYYY

Direct deposit information

By completing the information below, you authorize the company to initiate entries to your checking account at the financial institution indicated below and, if necessary, initiate adjustments for any transactions credited/debited in error. This authority will remain in effect until the company is notified by you in writing to cancel it in such time as to afford the comapny and financial institution a resonalbe opportunity to act on it.

Name of Financial Institution

ROUTING NUMBER

ACCOUNT NUMBER

CONFIRM ACCOUNT NUMBER

STATE TAX INFORMATION

NOTE: Please fill out your Georgia State G-4 Form and give it to your store manager!

Marital Status - state

NUMBER OF ALLOWANCES - STATE

Add the number of allowances on lines 3 - 5 of the State G-4.

NUMBER OF DEPENDENT ALLOWANCES - STATE

Number of dependent allowances on line 4

Additional Withholding - State