Section 1. Employee Information and Attestation (Employees must complete and sign Section 1 of Form I-9 no later than the first day of employment, but not before accepting a job offer.)
I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in connection with the completion of this form.
Aliens authorized to work must provide only one of the following document numbers to complete Form I-9:
An Alien Registration Number/USCIS Number OR Form I-94 Admission Number OR Foreign Passport Number.
(Fields below must be completed and signed when preparers and/or translators assist an employee in completing Section 1.)
I attest, under penalty of perjury, that I have assisted in the completion of Section 1 of this form and that to the best of my knowledge the information is true and correct.
Section 2. Employer or Authorized Representative Review and Verification
(Employers or their authorized representative must complete and sign Section 2 within 3 business days of the employee's first day of employment. You must physically examine one document from List A OR a combination of one document from List B and one document from List C as listed on the "Listsof Acceptable Documents.")
Certification: I attest, under penalty of perjury, that
(1) I have examined the document(s) presented by the above-named employee,
(2) the above-listed document(s) appear to be genuine and to relate to the employee named, and
(3) to the best of my knowledge the
the employee is authorized to work in the United States.
Section 3. Reverification and Rehires
(To be completed and signed by employer or authorized representative.)
Employee Information Form PLEASE WRITE LEGIBLY
(FOR TAX FILING PURPOSES)
DIRECT DEPOSIT INFO
Confirmation Statement
I authorize my employer Company to deposit my earnings into the bank account(s) specified above and, if necessary, to electronically debit my account(s) to correct erroneous entries. I certify my accounts allow these transactions. Furthermore, I certify that the above-listed account number accurately reflects my intended receiving account. I agree that direct deposit transactions I authorize comply with all applicable laws. My signature below indicates that I am agreeing that I am either the account holder or have the authority of the account holder to authorize my employer/company to make direct deposits into the named account. I understand that this authorization will remain in full force and effect until I notify the Company in writing that I wish to revoke my authorization. I understand that the Company requires at least 5 business days prior notice to cancel this authorization. I confirm that the above-named employee/worker has added or changed a bank account for direct deposit transactions processed by Paychex, Inc. I have reviewed the information provided, and it is accurate to the best of my knowledge. My signature below indicates that I have the authority to execute this document on behalf of the Client.
EMPLOYMENT / JOB APPLICATION
Applicant understands that this is an Equal Opportunity Employer and committed to excellence through diversity. In order to ensure this application is acceptable, please print or type with the application being fully completed in order for it to be considered.
Please complete each section EVEN IF you decide to attach a resume.
I, the Applicant, certify that my answers are true and honest to the best of my knowledge. If this application leads to my eventual employment, I understand that any false or misleading information in my application or interview may result in my employment being terminated.
Form W-4 Department of the Treasury
Internal Revenue Service
Employee’s Withholding Certificate
▶ Complete Form W-4 so that your employer can withhold the correct federal income tax from your pay.
▶ Give Form W-4 to your employer.
▶ Your withholding is subject to review by the IRS.
Step 1: Enter Personal Information
Step 4 (optional): Other Adjustments
(This form is not valid unless you sign it.)
Employers Only