New Hire / Employee ChangeBusiness Name*New employee or current employee change*New Employee (Fill out all information)Current Employee ChangeHUB Set-up:ESSPTO/OnlyClockEmployee Name*Social Security Number*Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Main Dept*Pay Rate*2nd DeptPay RateDate of Hire* Date Format: MM slash DD slash YYYY Date of Birth* Date Format: MM slash DD slash YYYY Email* DOB & Email Required for HUB ActivationFederal Filing Status*Use information found on Form W-4 (do not send W-4 to PaySmart, keep in employee records)SingleMarriedHead of HouseholdStep 2 Option CYesNoLine 3Line 4 (a)Line 4 (b)Line 4 (c)Township*School District*PSD Code (optional)Township & School district are required information found on certificate of residency. Missing information will result in processing delays.Withhold LST?*YesNoIf No, must provide exemption formEligible for time off benefits?*YesNoPayroll DeductionsDeductionAmountFrequencyStart DateBalance Due Reminders: PaySmart is not responsible for omitted or incorrect information contained on this form DO NOT send W-4, I-9, or Certificate of Residency to PaySmart Keep W-4 and Certificate of Residency with your employee records Keep I-9s together in a separate file, retain for 3 years from hire date or 1 year from termination date, whichever is longer CAPTCHA