New Hire Employee Form New Employee W-4 Personal Information Are You Revising A Previous W4 ? * Yes No Only mark yes if you are already an employee and are submitting a new w4 to change your tax witholdings or information. What Is The Name Of The Business Hiring You? * Type the name of the business that is hiring you First Name & Middle Initial * Must match ITIN or SS Card Last Name * Must match ITIN or SS Card Address (Required By California EDD) * Address (Required By California EDD) Address (Required By California EDD) Address (Required By California EDD) City City State/Province State/Province Zip/Postal Zip/Postal Social security number * Date of Birth * Date of birth Information is used by most States to verify Employees Email Address * Used To Send W2 Cell Phone Number * Used If Email Is Unsuccessful When Is Your First Day Of Employment? (Start Date) * Choose your Marital Status * Single Married Filing Joint Tax Retrurn Head Of Household (single parent claiming dependents) Do You Have More Than One Job? * Yes No If Married Does Your Spouse Work? * Yes No Not Married How Many Dependents UNDER 17 * 1 2 3 4 5 6 None How Many Dependents 17 or Older * 1 2 3 4 5 None Extra Withholding (Federal) Enter any additional FEDERAL tax you want to withhold each pay period Extra Withholding (State) Enter any additional STATE tax you want to withhold each pay period Claiming Exempt (Federal & State Withholdings Only) I Declare I Qualify To Go Exempt For Fed Tax Withholding. I Declare I Qualify To Go Exempt For State Tax Witholding. NOTE: Employees can only go exempt if In the previous year, you got a refund of all of your federal & state taxes & you expect a refund of all federal & state taxes again this year. Sign & Date - Under penalties of perjury, I declare that this certificate, to the best of my knowledge and belief, is true, correct, and complete Draw Signature Below This Line (Using Mouse) * signature keyboard Clear Signature Date * Please Attach A Copy Of Your SS or ITIN Card Here * Drop or click here to Upload a picture Of your SS Card Choose File Maximum file size: 104.86MB If you are human, leave this field blank. Submit
