NEW HIRE form – Talus Rock Retreat

Name *

First

Last

(b) Social security number

Does your name match the name on your social security card? If not, to ensure you get credit for your earnings, contact SSA at 800-772-1213 or go to www.ssa.gov.

Address

City or town, state, and ZIP code

Status

Single or Married filing separately
Married filing jointly or Qualifying surviving spouse
Head of household (Check only if you’re unmarried and pay more than half the costs of keeping up a home for yourself and a qualifying individual.)

If there are only two jobs total, you may check Yes or No box. Do the same on Form W-4 for the other job. This option is generally more accurate than (b) if pay at the lower paying job is more than half of the pay at the higher paying job. Otherwise, (b) is more accurate

If your total income will be $200,000 or less ($400,000 or less if married filing jointly):

Multiply the number of other dependents by $500

Add the amounts above for qualifying children and other dependents. You may add to this the amount of any other credits. Enter the total here

(a) Other income (not from jobs). If you want tax withheld for other income you expect this year that won’t have withholding, enter the amount of other income here. This may include interest, dividends, and retirement income

(b) Deductions. If you expect to claim deductions other than the standard deduction and want to reduce your withholding, use the Deductions Worksheet on page 3 and enter the result here .

Upload signature

Click or drag a file to this area to upload.

Employer’s name and address

First date of employment

Employer identification number (EIN)