Tax Form W4 Form W-4 Marital Status (Select One) Single Married Married, but withhold at Single rate Your Email Address First Name & Middle Initial * Last Name Social Security Number Address (Include Number, Street, and Apt# if applicable) City, State, Zip Code Total Number of Allowances You're Claiming (Click Here to Go to the IRS website and calculate this number) Additional amount, if any, you want withheld from each paycheck: Write "EXEMPT" if you claim exemption from having any money withheld from your paycheck. Leave blank if you are not exempt from withheld income taxes. You can claim this exemption if you meet both of the following: 1) Last year you had a right to a refund of all federal income tax withheld because you had no tax liability and 2) This year you expect a refund of all federal income tax withheld because you expect to have no tax liability. Check below if your last name is different than the last name on your social security card: Yes, my last name is different Signature Clear If you are human, leave this field blank. Submit Authorization to Work Form I9 Form I-9 Last Name * First Name * Middle Initial Other Last Names Used (If Applicable) Street Address * Apt # City * State * Zip Code * Date of Birth * Social Security Number Email Address Phone Number * I attest, under penalty of perjury, that I am... * A citizen of the United States A noncitizen national of the United States A lawful permanent resident 4. An alien authorized to work I am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in connection with the completion of this form. Alien Registration Number/USCIS Number: Until what date are you authorized to work? * Form I-94 Admission Number: Foreign Passport Number Country of Issuance Signature * Clear Today's Date * If you are human, leave this field blank. Submit
