New Hire / Employee Change Form

New Hire / Employee Change
Business Name*
New employee or current employee change*
- New Employee (Fill out all information)
- Current Employee Change
HUB Set-up:
ESS
PTO/Only
Clock
Employee Name*
Social Security Number*
Address*
Street Address Address Line 2 City State ZIP Code
Main Dept*
Pay Rate*
2nd Dept
Pay Rate
Date 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 Activation
Federal Filing Status*
Use information found on Form W-4 (do not send W-4 to PaySmart, keep in employee records)
- Single
- Married
- Head of Household
Step 2 Option C
- Yes
- No
Line 3
Line 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?*
- Yes
- No
If No, must provide exemption form
Eligible for time off benefits?*
- Yes
- No
Payroll Deductions
Deduction Amount Frequency Start Date Balance 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
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Deduction	Amount	Frequency	Start Date	Balance Due

New Hire / Employee Change