Employment Eligibility Verification - The Bin Store Liquidation Store

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.)

Your Name(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Date of Birth (mm/dd/yyyy)(Required)

U.S. Social Security Number(Required)

Employee's E-mail Address(Required)

Employee's Telephone Number(Required)

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.

I attest, under penalty of perjury, that I am (check one of the following boxes):

1. A citizen of the United States

2. A noncitizen national of the United States (See instructions)

3. A lawful permanent resident (Alien Registration Number/USCIS Number):

4. An alien authorized to work until (expiration date, if applicable, mm/dd/yyyy):

3. Alien Registration Number/USCIS Number:

4. (expiration date, if applicable, mm/dd/yyyy):

Some aliens may write "N/A" in the expiration date field. (See instructions)

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.

1. Alien Registration Number/USCIS Number:

2. Form I-94 Admission Number:

3. Foreign Passport Number:

Country of Issuance:

Signature of Employee(Required)

Today's Date (mm/dd/yyyy)

Preparer and/or Translator Certification (check one):

I did not use a preparer or translator.

A preparer(s) and/or translator(s) assisted the employee in completing Section 1.

(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.

Signature of Preparer or Translator

Today's Date (mm/dd/yyyy)

Name

First Name (Given Name) Last Name (Family Name)

Address

Street Address City State / Province / Region ZIP / Postal Code

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.")

Employee Info from Section 1

Last Name (Family Name)

First Name (Given Name)

M.I.

Citizenship/Immigration Status

List A: Identity and Employment Authorization

Document Title

Issuing Authority

Document Number

Expiration Date (if any) (mm/dd/yyyy)

List B: Identity

Document Title

Issuing Authority

Document Number

Expiration Date (if any) (mm/dd/yyyy)

List C: Employment Authorization

Document Title

Issuing Authority

Document Number

Expiration Date (if any) (mm/dd/yyyy)

Additional Information

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.

The employee's first day of employment (mm/dd/yyyy):(Required)

Signature of Employer or Authorized Representative

Today's Date (mm/dd/yyyy)

Title of Employer or Authorized Representative

Last Name of Employer or Authorized Representative

First Name of Employer or Authorized Representative

Employer's Business or Organization Name

Address

Employer's Business or Organization Address (Street Number and Name) City State / Province / Region ZIP / Postal Code

Section 3. Reverification and Rehires

(To be completed and signed by employer or authorized representative.)

A. New Name (if applicable)

Last Name (Family Name)

First Name (Given Name)

Middle Initial

B. Date of Rehire (if applicable) (mm/dd/yyyy)

C. If the employee's previous grant of employment authorization has expired, provide the information for the document or receipt that establishes continuing employment authorization in the space provided below.

Document Title

Document Number

Expiration Date (if any) (mm/dd/yyyy)

PERSONAL INFORMATION

Signature of Employer or Authorized Representative

Today's Date (mm/dd/yyyy)

Name of Employer or Authorized Representative

Employee Information Form PLEASE WRITE LEGIBLY

PREFERRED NAME:(Required)

Name(Required)

First Name MI Last Name

Address(Required)

Street Address APT City State / Province / Region ZIP / Postal Code

PHONE NUMBER:(Required)

SOCIAL SECURITY:(Required)

GENDER:

Male

Female

MARITAL STATUS:(Required)

Single

Married

(FOR TAX FILING PURPOSES)

# OF DEPENDENTS:(Required)

Additional Earnings or Deductions (401k, med-125, garnishments, etc.)

HIRE DATE:(Required)

BIRTH DATE:

EMAIL ADDRESS:(Required)

Earnings(Required)

HOURLY RATE: $

OR SALARY: $

DIRECT DEPOSIT INFO

CIRCLE ONE:(Required)

CHECKING

SAVINGS

BANK NAME:(Required)

ROUTING #:(Required)

ACCOUNT #:(Required)

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.

Employee/Worker Signature(Required)

Date

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.

Employer/Company Representative Printed Name:

Employer/Company Representative Signature:

Date

*All fields are required except Employee/Worker Number.

** Certain accounts may have restrictions on deposits and withdrawals. Check with your bank for more information specific to your account.

Note: Digital or Electronic Signatures are not acceptable.

EMPLOYMENT / JOB APPLICATION

PERSONAL INFORMATION

Name

First Middle Last

Phone

Date

Address

Street Address Apt/Suite City State / Province / Region ZIP / Postal Code

SOCIAL SECURITY NUMBER (SSN):

Date

DESIRED PAY: $

HOUR

SALARY

AMOUNT: $

POSITION APPLIED FOR:

EMPLOYMENT DESIRED:

FULL-TIME

PART-TIME

SEASONAL

EMPLOYMENT ELIGIBILITY

ARE YOU LEGALLY ELIGIBLE TO WORK IN THE U.S?

YES

HAVE YOU EVER WORKED FOR THIS EMPLOYER?

YES

IF YES, WRITE THE START AND END DATES:

HAVE YOU EVER BEEN CONVICTED OF A FELONY?

YES

*IF YES, PLEASE EXPLAIN:

EDUCATION

HIGH SCHOOL:

LOCATION

City State

HIGH SCHOOL:

FROM:

TO:

GRADUATE?

YES

DIPLOMA:

COLLEGE:

LOCATION

City State

COLLEGE:

FROM:

TO:

GRADUATE?

YES

DEGREE:

OTHER:

LOCATION

City State

OTHER:

FROM:

TO:

DEGREE/CERTIFICATION:

OTHER:

LOCATION

City State

OTHER:

FROM:

TO:

DEGREE/CERTIFICATION:

PREVIOUS EMPLOYMENT

EMPLOYER 1

Company / Individual

Phone

Address

Street Address Apt/Suite City State ZIP Code

STARTING PAY:

HOUR

SALARY

ENDING PAY:

HOUR

SALARY

STARTING PAY: $

ENDING PAY: $

JOB TITLE:

RESPONSIBILITIES:

EMPLOYER 1:

FROM:

TO:

REASON FOR LEAVING:

EMPLOYER 2

Company / Individual

Phone

Address

Street Address Apt/Suite City State ZIP Code

STARTING PAY:

HOUR

SALARY

ENDING PAY:

HOUR

SALARY

STARTING PAY: $

ENDING PAY: $

EMPLOYER 2:

FROM:

TO:

JOB TITLE:

RESPONSIBILITIES:

REASON FOR LEAVING:

MILITARY SERVICE

ARE YOU A VETERAN?

YES

BRANCH:

RANK AT DISCHARGE:

MILITARY SERVICE

FROM:

TO:

TYPE OF DISCHARGE

IF NOT HONORABLE, PLEASE EXPLAIN

BACKGROUND CHECK CONSENT

IF ASKED, ARE YOU WILLING TO CONSENT TO A BACKGROUND CHECK?

YES

DISCLAIMER

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.

SIGNATURE

DATE

PRINT NAME

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

(a) Name

First name and middle initial Last Name

(b) Social security number

▶ Does your name match the name on your social security card? If not, to ensure you get credit for your earnings, contact SSA at 800-772-1213 or go to www.ssa.gov.

Address

Street Address City State / Province / Region ZIP / Postal Code Country

(c)

Single or Married filing separately

Married filing jointly or Qualifying widow(er)

Head of household (Check only if you’re unmarried and pay more than half the costs of keeping up a home for yourself and a qualifying individual.)

Complete Steps 2–4 ONLY if they apply to you; otherwise, skip to Step 5. See page 2 for more information on each step, who can claim exemption from withholding, when to use the estimator at www.irs.gov/W4App, and privacy.

Step 2: Multiple Jobs or Spouse Works

Complete this step if you (1) hold more than one job at a time, or (2) are married filing jointly and your spouse also works. The correct amount of withholding depends on income earned from all of these jobs.

Do only one of the following.

(a) Use the estimator at www.irs.gov/W4App for most accurate withholding for this step (and Steps 3–4); or

(b) Use the Multiple Jobs Worksheet on page 3 and enter the result in Step 4(c) below for roughly accurate withholding; or

(c) If there are only two jobs total, you may check this box. Do the same on Form W-4 for the other job. This option is accurate for jobs with similar pay; otherwise, more tax than necessary may be withheld . . ▶

TIP: To be accurate, submit a 2022 Form W-4 for all other jobs. If you (or your spouse) have self-employment income, including as an independent contractor, use the estimator.

Complete Steps 3–4(b) on Form W-4 for only ONE of these jobs. Leave those steps blank for the other jobs. (Your withholding will be most accurate if you complete Steps 3–4(b) on the Form W-4 for the highest paying job.)

Step 3: Claim Dependents

If your total income will be $200,000 or less ($400,000 or less if married filing jointly):

Multiply the number of qualifying children under age 17 by $2,000

Multiply the number of other dependents by $500

Add the amounts above and enter the total here. $

Step 4 (optional): Other Adjustments

(a) Other income (not from jobs). If you want tax withheld for other income you expect this year that won’t have withholding, enter the amount of other income here. This may include interest, dividends, and retirement income. $

(b) Deductions. If you expect to claim deductions other than the standard deduction and want to reduce your withholding, use the Deductions Worksheet on page 3 and enter the result here.. $

Step 5: Sign Here

Under penalties of perjury, I declare that this certificate, to the best of my knowledge and belief, is true, correct, and complete.

Employee’s signature(Required)

(This form is not valid unless you sign it.)

Date

Employers Only

Employer’s name

First Last

Employer’s Address

Street Address City State / Province / Region ZIP / Postal Code Country

First date of employment

Employer identification number (EIN)

Facebook Tweet Pin Share LinkedIn