Employee Information/Update @Adult DayCare

Superior Adult DayCare

1501 Clinton St. St. Louis MO. 63106

Tel 314-921-2625 Fax 314-921-2625

Superior314@gmail.com

Superior314.com
Employee Information Sheet
Job location:
Job title:
CONSUMER NAME

First NameLast Name
EMPLOYEE NAME

First NameLast Name
Employee Code
STREET
City
State
ZIP
Phone Number
Emergency Contact Home
Phone Number
Social Security #
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Hire Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Hourly Rate
Salary Rate
Other Rate
Marital status (select one)
If married note if spouse work
Number of dependents
Federal
State
Additional Federal tax withheld
Additional state tax withheld
City Tax
Banking information Please include a voided check for direct deposit
Routing number
Account number
Please Sign and Date verifying all information is correct.
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Note Changes
Should be Empty: