New Employee Submission

Client Company*
For what company will this new employee work?

Submitted By*
Please enter your full name here.

First Name*
Enter the new employee's first name, as it appears on their Social Security card.

Middle Initial

Last Name*
Enter the new employee's last name, as it appears on their Social Security card.

SSN*

Date of Birth*

Gender*

Date of Hire*
This date will be the one reported to the state when the New Hire report is filed.

Wage/Salary*
Please enter only the amount, no dollar signs. For example, $10.25/hour should be entered as 10.25 here.

Per*
Choose the unit of pay corresponding to the amount you entered above. For example, $10.25/hour would mean Hour should be chosen here.

Street Address*

City*

State*
Use the two-letter postal abbreviation for the state, e.g. SC for South Carolina.

ZIP*

County of Residence*

Email Address*
Please enter the new employee's email address here. This will be where notifications will be sent for pay stubs.

Telephone

Employment Status*

Comments
Please enter any additional information we might need to set up this new employee, such as vacation, benefits, garnishments, etc. and attach supporting documents.

File Attachments
Please upload any related documents here, including Social Security card, driver's license, passport, etc. that we might need to Everify your new employee.

Send me a copy of my responses

Email address