EMPLOYEE INFORMATION SHEET
Company Name						Date
Employee Information:
Last Name					Fed Filing Status
First Name / MI					Fed Exemptions
Address					Addt'l Fed W/H
City, St, Zip					State Filing Status
Soc Sec #					State Exemptions
Sex of Employee					Addt'l State W/H
Phone Number					City Filing Status
Hire Date					City Exemptions
Birth Date					Salary Rate
					Hourly Rate
Deductions:
Description					Amount
Special Instructions: