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New Employee Form
*W-4 and I-9 forms must be filled out and faxed to our office along with this form.
Fax# (310) 732-1339
If you would rather print this form, fill it out and fax it over to us, please
click here
Personal Information:
Company Name:
Telephone:
First Name:
Middle Name:
Last Name:
SSN:
-
-
Gender:
Male
Female
DOB:
Marital Status:
Married
Single
U.S. Citizen:
Yes
No
Ethnicity:
Disability:
Yes
No
I-9 Work Authorization:
Yes
No
Military:
U.S Veteran:
Yes
No
Status:
Active
Not Active
Address:
City:
State:
Zip Code:
Telephone:
Cell:
Fax:
Email:
Emergency Contact:
Name:
Telephone:
Relationship:
Secondary Contact:
Name:
Telephone:
Relationship:
Payroll Information:
Full Time
Part Time
Salary:
Hourly:
Commission:
Benefits:
Medical:
Yes
No
Vacation:
Yes
No
Holiday Paid:
Yes
No
Dependent/Allowances:
Federal (W-4):
State (DE-4):
Exemption:
Copyright © SHANE FINANCIAL Certified Public Accountant
South Bay:
(877) SHANE4ME
(877) 742-6346
(310) 986-8276
(310) 732-1339
San Fernando Valley:
(877) TZURCPA
(877) 898-7272
(818) 654-5701
Fax: (818) 345-8993
San Deigo:
(858) 699-5474
Israel:
03-97895554