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:  
First Name: Middle Name:
Last Name: SSN: - -
U.S. Citizen:
I-9 Work Authorization: Yes No Military: U.S Veteran: Yes No Status:
Address: City: Zip Code:
Telephone: Cell:
Fax: Email:
Emergency Contact:
Name: Telephone: Relationship:
Secondary Contact:
Name: Telephone: Relationship:
Payroll Information:
Benefits: Medical: Yes No Vacation: Yes No Holiday Paid: Yes No
Dependent/Allowances: Federal (W-4): State (DE-4): Exemption: