Fillable Employee Information Form (College of Southern Idaho)

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Employee Information Form (College of Southern Idaho)

On average this form takes 57 minutes to complete

The Employee Information Form (College of Southern Idaho) form is 25 pages long and contains:

  • 2 signatures
  • 20 check-boxes
  • 211 other fields

Country of origin: US
File type: PDF

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Please PRINT
Full Legal Name
Sex ( M/F)
Marital M
Status: S
As it appears on your Social Security Card
Nickname/Preferred Name
Date of Birth
Social Security #
Telephone
Address
City
State
Zip
Address
City
State
Zip
All payroll checks issued will be mailed to the mailing address listed above
Yes
No
Personal Email Address
Are you currently receiving a PERSI pension? Yes
No
Are you a current CSI student enrolled in 6 or more credits?
EMERGENCY CONTACT INFORMATION
Contact 1
Relationship
Contact 2
Relationship
Contact Phone
Contact Phone
The Following data is for statistical analysis with respect to the success of our affirmative action program.
SUBMISSION OF THIS INFORMATION IS VOLUNTARY. Please check only one.
Do you consider yourself to be Hispanic/Latino?
Yes
No
Select one or more of the following racial categories to describe yourself.
American Indian or Native American
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Date
Employee Information Form
Download to your PC for fillable forms. (Rev: 8/2020)
Return completed form to HR Department.
Employee’s Signature
Rev: 8/2020
Yes No
Form W-4
2020
Employee’s Withholding Certificate
Department of the Treasury
Internal Revenue Service
▶
Complete Form W-4 so that your employer can withhold the correct federal income tax from your pay.
▶
Give Form W-4 to your employer.
▶
Your withholding is subject to review by the IRS.
OMB No. 1545-0074
Step 1:
Enter
Personal
Information
(a) First name and middle initial Last name
Address
City or town, state, and ZIP code
(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.
(c)
Single or Married filing separately
Married filing jointly (or Qualifying widow(er))
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.)
Complete Steps 2–4 ONLY if they apply to you; otherwise, skip to Step 5. See page 2 for more information on each step, who can
claim exemption from withholding, when to use the online estimator, and privacy.
Step 2:
Multiple Jobs
or Spouse
Works
Complete this step if you (1) hold more than one job at a time, or (2) are married filing jointly and your spouse
also works. The correct amount of withholding depends on income earned from all of these jobs.
Do only one of the following.
(a) Use the estimator at www.irs.gov/W4App for most accurate withholding for this step (and Steps 3–4); or
(b)
Use the Multiple Jobs Worksheet on page 3 and enter the result in Step 4(c) below for roughly accurate withholding; or
(c)
If there are only two jobs total, you may check this box. Do the same on Form W-4 for the other job. This option
is accurate for jobs with similar pay; otherwise, more tax than necessary may be withheld . . . . .
▶
TIP: To be accurate, submit a 2020 Form W-4 for all other jobs. If you (or your spouse) have self-employment
income, including as an independent contractor, use the estimator.
Complete Steps 3–4(b) on Form W-4 for only ONE of these jobs. Leave those steps blank for the other jobs. (Your withholding will
be most accurate if you complete Steps 3–4(b) on the Form W-4 for the highest paying job.)
Step 3:
Claim
Dependents
If your income will be $200,000 or less ($400,000 or less if married filing jointly):
Multiply the number of qualifying children under age 17 by $2,000
▶
$
Multiply the number of other dependents
by $500 . . . .
▶
$
Add the amounts above and enter the total here . . . . . . . . . . . . .
3 $
Step 4
(optional):
Other
Adjustments
(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 . . . . . . . . . . . .
4(a) $
(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 . . . . . . . . . . . . . . . . . . . . .
4(b) $
(c) Extra withholding. Enter any additional tax you want withheld each pay period .
4(c)
$
Step 5:
Sign
Here
Under penalties of perjury, I declare that this certificate, to the best of my knowledge and belief, is true, correct, and complete.
▲
Employee’s signature (This form is not valid unless you sign it.)
▲
Date
Employers
Only
Employer’s name and address First date of
employment
Employer identification
number (EIN)
For Privacy Act and Paperwork Reduction Act Notice, see page 3.
Cat. No. 10220Q
Form W-4 (2020)
College of Southern Idaho
PO Box 1238
Twin Falls, ID 83301
82-0261628
click to sign
signature
click to edit
Form W-4 (2020)
Page 2
General Instructions
Future Developments
For the latest information about developments related to
Form W-4, such as legislation enacted after it was published,
go to www.irs.gov/FormW4.
Purpose of Form
Complete Form W-4 so that your employer can withhold the
correct federal income tax from your pay. If too little is
withheld, you will generally owe tax when you file your tax
return and may owe a penalty. If too much is withheld, you will
generally be due a refund. Complete a new Form W-4 when
changes to your personal or financial situation would change
the entries on the form. For more information on withholding
and when you must furnish a new Form W-4, see Pub. 505.
Exemption from withholding. You may claim exemption from
withholding for 2020 if you meet both of the following
conditions: you had no federal income tax liability in 2019 and
you expect to have no federal income tax liability in 2020. You
had no federal income tax liability in 2019 if (1) your total tax on
line 16 on your 2019 Form 1040 or 1040-SR is zero (or less
than the sum of lines 18a, 18b, and 18c), or (2) you were not
required to file a return because your income was below the
filing threshold for your correct filing status. If you claim
exemption, you will have no income tax withheld from your
paycheck and may owe taxes and penalties when you file your
2020 tax return. To claim exemption from withholding, certify
that you meet both of the conditions above by writing “Exempt”
on Form W-4 in the space below Step 4(c). Then, complete
Steps 1a, 1b, and 5. Do not complete any other steps. You will
need to submit a new Form W-4 by February 16, 2021.
Your privacy. If you prefer to limit information provided in
Steps 2 through 4, use the online estimator, which will also
increase accuracy.
As an alternative to the estimator: if you have concerns
with Step 2(c), you may choose Step 2(b); if you have
concerns with Step 4(a), you may enter an additional amount
you want withheld per pay period in Step 4(c). If this is the
only job in your household, you may instead check the box
in Step 2(c), which will increase your withholding and
significantly reduce your paycheck (often by thousands of
dollars over the year).
When to use the estimator. Consider using the estimator at
www.irs.gov/W4App if you:
1. Expect to work only part of the year;
2. Have dividend or capital gain income, or are subject to
additional taxes, such as the additional Medicare tax;
3. Have self-employment income (see below); or
4. Prefer the most accurate withholding for multiple job
situations.
Self-employment. Generally, you will owe both income and
self-employment taxes on any self-employment income you
receive separate from the wages you receive as an
employee. If you want to pay these taxes through
withholding from your wages, use the estimator at
www.irs.gov/W4App to figure the amount to have withheld.
Nonresident alien. If you’re a nonresident alien, see Notice
1392, Supplemental Form W-4 Instructions for Nonresident
Aliens, before completing this form.
Specific Instructions
Step 1(c). Check your anticipated filing status. This will
determine the standard deduction and tax rates used to
compute your withholding.
Step 2. Use this step if you (1) have more than one job at the
same time, or (2) are married filing jointly and you and your
spouse both work.
Option (a) most accurately calculates the additional tax
you need to have withheld, while option (b) does so with a
little less accuracy.
If you (and your spouse) have a total of only two jobs, you
may instead check the box in option (c). The box must also be
checked on the Form W-4 for the other job. If the box is
checked, the standard deduction and tax brackets will be cut
in half for each job to calculate withholding. This option is
roughly accurate for jobs with similar pay; otherwise, more tax
than necessary may be withheld, and this extra amount will be
larger the greater the difference in pay is between the two jobs.
▲
!
CAUTION
Multiple jobs. Complete Steps 3 through 4(b) on only
one Form W-4. Withholding will be most accurate if
you do this on the Form W-4 for the highest paying job.
Step 3. Step 3 of Form W-4 provides instructions for
determining the amount of the child tax credit and the credit
for other dependents that you may be able to claim when
you file your tax return. To qualify for the child tax credit, the
child must be under age 17 as of December 31, must be
your dependent who generally lives with you for more than
half the year, and must have the required social security
number. You may be able to claim a credit for other
dependents for whom a child tax credit can’t be claimed,
such as an older child or a qualifying relative. For additional
eligibility requirements for these credits, see Pub. 972, Child
Tax Credit and Credit for Other Dependents. You can also
include other tax credits in this step, such as education tax
credits and the foreign tax credit. To do so, add an estimate
of the amount for the year to your credits for dependents
and enter the total amount in Step 3. Including these credits
will increase your paycheck and reduce the amount of any
refund you may receive when you file your tax return.
Step 4 (optional).
Step 4(a). Enter in this step the total of your other
estimated income for the year, if any. You shouldn’t include
income from any jobs or self-employment. If you complete
Step 4(a), you likely won’t have to make estimated tax
payments for that income. If you prefer to pay estimated tax
rather than having tax on other income withheld from your
paycheck, see Form 1040-ES, Estimated Tax for Individuals.
Step 4(b). Enter in this step the amount from the Deductions
Worksheet, line 5, if you expect to claim deductions other than
the basic standard deduction on your 2020 tax return and
want to reduce your withholding to account for these
deductions. This includes both itemized deductions and other
deductions such as for student loan interest and IRAs.
Step 4(c). Enter in this step any additional tax you want
withheld from your pay each pay period, including any
amounts from the Multiple Jobs Worksheet, line 4. Entering an
amount here will reduce your paycheck and will either increase
your refund or reduce any amount of tax that you owe.
Form W-4 (2020)
Page 3
Step 2(b)—Multiple Jobs Worksheet (Keep for your records.)
If you choose the option in Step 2(b) on Form W-4, complete this worksheet (which calculates the total extra tax for all jobs) on only ONE
Form W-4. Withholding will be most accurate if you complete the worksheet and enter the result on the Form W-4 for the highest paying job.
Note: If more than one job has annual wages of more than $120,000 or there are more than three jobs, see Pub. 505 for additional
tables; or, you can use the online withholding estimator at www.irs.gov/W4App.
1
Two jobs. If you have two jobs or you’re married filing jointly and you and your spouse each have one
job, find the amount from the appropriate table on page 4. Using the “Higher Paying Job” row and the
“Lower Paying Job” column, find the value at the intersection of the two household salaries and enter
that value on line 1. Then, skip to line 3 . . . . . . . . . . . . . . . . . . . . . 1 $
2 Three jobs. If you and/or your spouse have three jobs at the same time, complete lines 2a, 2b, and
2c below. Otherwise, skip to line 3.
a
Find the amount from the appropriate table on page 4 using the annual wages from the highest
paying job in the “Higher Paying Job” row and the annual wages for your next highest paying job
in the “Lower Paying Job” column. Find the value at the intersection of the two household salaries
and enter that value on line 2a . . . . . . . . . . . . . . . . . . . . . . . 2a
$
b
Add the annual wages of the two highest paying jobs from line 2a together and use the total as the
wages in the “Higher Paying Job” row and use the annual wages for your third job in the “Lower
Paying Job” column to find the amount from the appropriate table on page 4 and enter this amount
on line 2b . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2b $
c Add the amounts from lines 2a and 2b and enter the result on line 2c . . . . . . . . . . 2c
$
3 Enter the number of pay periods per year for the highest paying job. For example, if that job pays
weekly, enter 52; if it pays every other week, enter 26; if it pays monthly, enter 12, etc. . . . . . 3
4
Divide the annual amount on line 1 or line 2c by the number of pay periods on line 3. Enter this
amount here and in Step 4(c) of Form W-4 for the highest paying job (along with any other additional
amount you want withheld) . . . . . . . . . . . . . . . . . . . . . . . . . 4 $
Step 4(b)—Deductions Worksheet (Keep for your records.)
1
Enter an estimate of your 2020 itemized deductions (from Schedule A (Form 1040 or 1040-SR)). Such
deductions may include qualifying home mortgage interest, charitable contributions, state and local
taxes (up to $10,000), and medical expenses in excess of 10% of your income . . . . . . . . 1 $
2 Enter:
{
• $24,800 if you’re married filing jointly or qualifying widow(er)
• $18,650 if you’re head of household
• $12,400 if you’re single or married filing separately
}
. . . . . . . . 2 $
3 If line 1 is greater than line 2, subtract line 2 from line 1. If line 2 is greater than line 1, enter “-0-” . . 3 $
4 Enter an estimate of your student loan interest, deductible IRA contributions, and certain other
adjustments (from Schedule 1 (Form 1040 or 1040-SR)). See Pub. 505 for more information . . . 4 $
5 Add lines 3 and 4. Enter the result here and in Step 4(b) of Form W-4 . . . . . . . . . . . 5 $
Privacy Act and Paperwork Reduction Act Notice. We ask for the information
on this form to carry out the Internal Revenue laws of the United States. Internal
Revenue Code sections 3402(f)(2) and 6109 and their regulations require you to
provide this information; your employer uses it to determine your federal income
tax withholding. Failure to provide a properly completed form will result in your
being treated as a single person with no other entries on the form; providing
fraudulent information may subject you to penalties. Routine uses of this
information include giving it to the Department of Justice for civil and criminal
litigation; to cities, states, the District of Columbia, and U.S. commonwealths and
possessions for use in administering their tax laws; and to the Department of
Health and Human Services for use in the National Directory of New Hires. We
may also disclose this information to other countries under a tax treaty, to federal
and state agencies to enforce federal nontax criminal laws, or to federal law
enforcement and intelligence agencies to combat terrorism.
You are not required to provide the information requested on a form that is
subject to the Paperwork Reduction Act unless the form displays a valid OMB
control number. Books or records relating to a form or its instructions must be
retained as long as their contents may become material in the administration of
any Internal Revenue law. Generally, tax returns and return information are
confidential, as required by Code section 6103.
The average time and expenses required to complete and file this form will vary
depending on individual circumstances. For estimated averages, see the
instructions for your income tax return.
If you have suggestions for making this form simpler, we would be happy to hear
from you. See the instructions for your income tax return.
Form W-4 (2020)
Page 4
Married Filing Jointly or Qualifying Widow(er)
Higher Paying Job
Annual Taxable
Wage & Salary
Lower Paying Job Annual Taxable Wage & Salary
$0 -
9,999
$10,000 -
19,999
$20,000 -
29,999
$30,000 -
39,999
$40,000 -
49,999
$50,000 -
59,999
$60,000 -
69,999
$70,000 -
79,999
$80,000 -
89,999
$90,000 -
99,999
$100,000 -
109,999
$110,000 -
120,000
$0 - 9,999 $0 $220 $850 $900 $1,020 $1,020 $1,020 $1,020 $1,020 $1,210 $1,870 $1,870
$10,000 - 19,999
220 1,220 1,900 2,100 2,220 2,220 2,220 2,220 2,410 3,410 4,070 4,070
$20,000 - 29,999 850 1,900 2,730 2,930 3,050 3,050 3,050 3,240 4,240 5,240 5,900 5,900
$30,000 - 39,999
900 2,100 2,930 3,130 3,250 3,250 3,440 4,440 5,440 6,440 7,100 7,100
$40,000 - 49,999
1,020 2,220 3,050 3,250 3,370 3,570 4,570 5,570 6,570 7,570 8,220 8,220
$50,000 - 59,999 1,020 2,220 3,050 3,250 3,570 4,570 5,570 6,570 7,570 8,570 9,220 9,220
$60,000 - 69,999
1,020 2,220 3,050 3,440 4,570 5,570 6,570 7,570 8,570 9,570 10,220 10,220
$70,000 - 79,999
1,020 2,220 3,240 4,440 5,570 6,570 7,570 8,570 9,570 10,570 11,220 11,240
$80,000 - 99,999 1,060 3,260 5,090 6,290 7,420 8,420 9,420 10,420 11,420 12,420 13,260 13,460
$100,000 - 149,999
1,870 4,070 5,900 7,100 8,220 9,320 10,520 11,720 12,920 14,120 14,980 15,180
$150,000 - 239,999
2,040 4,440 6,470 7,870 9,190 10,390 11,590 12,790 13,990 15,190 16,050 16,250
$240,000 - 259,999 2,040 4,440 6,470 7,870 9,190 10,390 11,590 12,790 13,990 15,520 17,170 18,170
$260,000 - 279,999
2,040 4,440 6,470 7,870 9,190 10,390 11,590 13,120 15,120 17,120 18,770 19,770
$280,000 - 299,999
2,040 4,440 6,470 7,870 9,190 10,720 12,720 14,720 16,720 18,720 20,370 21,370
$300,000 - 319,999 2,040 4,440 6,470 8,200 10,320 12,320 14,320 16,320 18,320 20,320 21,970 22,970
$320,000 - 364,999
2,720 5,920 8,750 10,950 13,070 15,070 17,070 19,070 21,290 23,590 25,540 26,840
$365,000 - 524,999
2,970 6,470 9,600 12,100 14,530 16,830 19,130 21,430 23,730 26,030 27,980 29,280
$525,000 and over
3,140 6,840 10,170 12,870 15,500 18,000 20,500 23,000 25,500 28,000 30,150 31,650
Single or Married Filing Separately
Higher Paying Job
Annual Taxable
Wage & Salary
Lower Paying Job Annual Taxable Wage & Salary
$0 -
9,999
$10,000 -
19,999
$20,000 -
29,999
$30,000 -
39,999
$40,000 -
49,999
$50,000 -
59,999
$60,000 -
69,999
$70,000 -
79,999
$80,000 -
89,999
$90,000 -
99,999
$100,000 -
109,999
$110,000 -
120,000
$0 - 9,999 $460 $940 $1,020 $1,020 $1,470 $1,870 $1,870 $1,870 $1,870 $2,040 $2,040 $2,040
$10,000 - 19,999
940 1,530 1,610 2,060 3,060 3,460 3,460 3,460 3,640 3,830 3,830 3,830
$20,000 - 29,999 1,020 1,610 2,130 3,130 4,130 4,540 4,540 4,720 4,920 5,110 5,110 5,110
$30,000 - 39,999
1,020 2,060 3,130 4,130 5,130 5,540 5,720 5,920 6,120 6,310 6,310 6,310
$40,000 - 59,999
1,870 3,460 4,540 5,540 6,690 7,290 7,490 7,690 7,890 8,080 8,080 8,080
$60,000 - 79,999 1,870 3,460 4,690 5,890 7,090 7,690 7,890 8,090 8,290 8,480 9,260 10,060
$80,000 - 99,999
2,020 3,810 5,090 6,290 7,490 8,090 8,290 8,490 9,470 10,460 11,260 12,060
$100,000 - 124,999
2,040 3,830 5,110 6,310 7,510 8,430 9,430 10,430 11,430 12,420 13,520 14,620
$125,000 - 149,999 2,040 3,830 5,110 7,030 9,030 10,430 11,430 12,580 13,880 15,170 16,270 17,370
$150,000 - 174,999
2,360 4,950 7,030 9,030 11,030 12,730 14,030 15,330 16,630 17,920 19,020 20,120
$175,000 - 199,999
2,720 5,310 7,540 9,840 12,140 13,840 15,140 16,440 17,740 19,030 20,130 21,230
$200,000 - 249,999 2,970 5,860 8,240 10,540 12,840 14,540 15,840 17,140 18,440 19,730 20,830 21,930
$250,000 - 399,999
2,970 5,860 8,240 10,540 12,840 14,540 15,840 17,140 18,440 19,730 20,830 21,930
$400,000 - 449,999
2,970 5,860 8,240 10,540 12,840 14,540 15,840 17,140 18,450 19,940 21,240 22,540
$450,000 and over
3,140 6,230 8,810 11,310 13,810 15,710 17,210 18,710 20,210 21,700 23,000 24,300
Head of Household
Higher Paying Job
Annual Taxable
Wage & Salary
Lower Paying Job Annual Taxable Wage & Salary
$0 -
9,999
$10,000 -
19,999
$20,000 -
29,999
$30,000 -
39,999
$40,000 -
49,999
$50,000 -
59,999
$60,000 -
69,999
$70,000 -
79,999
$80,000 -
89,999
$90,000 -
99,999
$100,000 -
109,999
$110,000 -
120,000
$0 - 9,999 $0 $830 $930 $1,020 $1,020 $1,020 $1,480 $1,870 $1,870 $1,930 $2,040 $2,040
$10,000 - 19,999
830 1,920 2,130 2,220 2,220 2,680 3,680 4,070 4,130 4,330 4,440 4,440
$20,000 - 29,999 930 2,130 2,350 2,430 2,900 3,900 4,900 5,340 5,540 5,740 5,850 5,850
$30,000 - 39,999
1,020 2,220 2,430 2,980 3,980 4,980 6,040 6,630 6,830 7,030 7,140 7,140
$40,000 - 59,999
1,020 2,530 3,750 4,830 5,860 7,060 8,260 8,850 9,050 9,250 9,360 9,360
$60,000 - 79,999 1,870 4,070 5,310 6,600 7,800 9,000 10,200 10,780 10,980 11,180 11,580 12,380
$80,000 - 99,999
1,900 4,300 5,710 7,000 8,200 9,400 10,600 11,180 11,670 12,670 13,580 14,380
$100,000 - 124,999
2,040 4,440 5,850 7,140 8,340 9,540 11,360 12,750 13,750 14,750 15,770 16,870
$125,000 - 149,999 2,040 4,440 5,850 7,360 9,360 11,360 13,360 14,750 16,010 17,310 18,520 19,620
$150,000 - 174,999
2,040 5,060 7,280 9,360 11,360 13,480 15,780 17,460 18,760 20,060 21,270 22,370
$175,000 - 199,999
2,720 5,920 8,130 10,480 12,780 15,080 17,380 19,070 20,370 21,670 22,880 23,980
$200,000 - 249,999 2,970 6,470 8,990 11,370 13,670 15,970 18,270 19,960 21,260 22,560 23,770 24,870
$250,000 - 349,999
2,970 6,470 8,990 11,370 13,670 15,970 18,270 19,960 21,260 22,560 23,770 24,870
$350,000 - 449,999
2,970 6,470 8,990 11,370 13,670 15,970 18,270 19,960 21,260 22,560 23,900 25,200
$450,000 and over 3,140 6,840 9,560 12,140 14,640 17,140 19,640 21,530 23,030 24,530 25,940 27,240
EFO00307 06-11-2020 Page 1 of 2
Form ID W-4
Employee’s Withholding Allowance Certicate
Complete Form ID W-4 so your employer can withhold the correct amount of state income tax from
your paycheck. Sign the form and give it to your employer. Use the information on the back to
calculate your Idaho allowances and any additional amount you need withheld from each paycheck.
If you plan to itemize deductions, use the worksheet at tax.idaho.gov/w4.
Withholding Status
Check the “A” box (Single) if you’re:
• Single with one job or single with multiple jobs
• Filing as head of household
Check the “B” box (Married) if you’re:
• Married ling jointly with one job and your spouse doesn’t work
• A qualifying widow(er)
Check the “C” box (Married, but withhold at Single rate) if you’re:
• Married ling jointly and both people work (or you have multiple jobs)
• Married ling separately
Form ID W-4
Employee’s Withholding Allowance Certicate
WITHHOLDING STATUS (see information above)
A
(Single)
B
(Married)
C
(Married, but withhold at Single rate)
1. Total number of Idaho allowances you’re claiming ...........................................................................
2. Additional amount (if any) you need withheld from each paycheck (Enter whole dollars) ...............
Your Social Security number (required)
Your rst name and initial Last name
Current mailing address
City State ZIP Code
Under penalties of perjury, I declare that to the best of my knowledge and belief I can claim the number of withholding
allowances on line 1 above.
Your signature Date
1. Total number of allowances you’re claiming.
Enter the number of children in your household age 16 or under as of December 31, 2020. If you have no qualifying children,
enter “0.” If your ling status will be head of household on your tax return, add “2” to the number of qualifying children. Don’t
claim allowances for you or your spouse. You can claim fewer allowances but not more.
If you’re married, claim your allowances on the W-4 for the highest-paying job for the most accurate withholding. If you’re
married ling jointly, only one of you should claim the allowances. The other should claim zero allowances.
If you work for more than one employer at the same time, you should claim zero allowances on your W-4 with any employer
other than your principal employer.
Write Exempt on line 1 if you meet both of the following conditions:
• Last year I had no Idaho income tax liability and
• This year I expect to have no Idaho income tax liability
Nonresident Aliens
Exempt income. If you’re a nonresident alien and all your income is exempt from withholding, write “Exempt” on line 1.
Exempt income from a treaty. If a treaty exempts a portion of your income from withholding, complete federal Form 8233 to
claim your treaty benets and complete the Idaho W-4 to withhold on income that’s not exempt by your treaty.
Idaho taxable income. If you’re a nonresident alien and have Idaho taxable income, do all of these:
1. Check the “Single” withholding status box regardless of your martial status.
2. Enter 0 on line 1.
3. Using the Pay Period table below, enter the additional amount of income tax to be withheld for each pay period on
line 2. Exception: If you’re a student or business apprentice from India, report $0 on line 2.
Pay Period Table
If your pay period is: Weekly Biweekly Semimonthly Monthly
Enter this amount on line 2: $17 $33 $36 $72
The withholding table calculations for employers include the standard deduction. Because nonresident aliens
don’t qualify for the standard deduction, the Pay Period table helps ensure that employers withhold enough.
2. Additional amount, if any, you need withheld from each paycheck.
If you’re single or married ling separately and have more than one job at a time, complete the worksheet below to
calculate any additional amount you need withheld from each paycheck.
1.
Other than your primary job, how many jobs do you expect to have at the
same time during 2020? (Don’t count your primary job.) .....................................................................
2. Multiply the number on line 1 by $12,400 ............................................................................................
3.
Enter an estimate of your 2020 income from other jobs
(not including your primary job) ...........................................................................................................
4. Enter the smaller of lines 2 or 3 ..........................................................................................................
5.
If you completed the itemized deduction worksheet for Idaho (tax.idaho.gov/w4), enter the
number from line 4. Otherwise, enter “0” ............................................................................................
6. Multiply the number on line 5 by $2,960..............................................................................................
7. Subtract line 6 from line 4 ...................................................................................................................
8.
Multiply line 7 by 6.925% (.06925). This is the additional amount you need to
withhold annually ................................................................................................................................
9.
Divide the amount on line 8 by the number of your remaining pay periods
in 2020. Enter the number on line 2 of the W-4 as the additional amount
you need withheld from each paycheck .............................................................................................
Contact us:
In the Boise area: (208) 334-7660 | Toll free: (800) 972-7660
Hearing impaired (TDD) (800) 377-3529
tax.idaho.gov/contact
EFO00307 06-11-2020 Page 2 of 2
Form ID W-4 (continued)
USCIS
Form I-9
OMB No. 1615-0047
Expires 10/31/2022
Employment Eligibility Verification
Department of Homeland Security
U.S. Citizenship and Immigration Services
Form I-9 10/21/2019
Page 1 of 3
►START HERE: Read instructions carefully before completing this form. The instructions must be available, either in paper or electronically,
during completion of this form. Employers are liable for errors in the completion of this form.
ANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work-authorized individuals. Employers CANNOT specify which document(s) an
employee may present to establish employment authorization and identity. The refusal to hire or continue to employ an individual because the
documentation presented has a future expiration date may also constitute illegal discrimination.
Section 1. Employee Information and Attestation (Employees must complete and sign Section 1 of Form I-9 no later
than the first day of employment, but not before accepting a job offer.)
Last Name (Family Name)
First Name (Given Name)
Middle Initial
Other Last Names Used (if any)
Address (Street Number and Name)
Apt. Number
City or Town
State
ZIP Code
Date of Birth (mm/dd/yyyy)
-
-
Employee's E-mail Address
Employee's Telephone Number
U.S. Social Security Number
1. A citizen of the United States
2. A noncitizen national of the United States (See instructions)
3. A lawful permanent resident
4. An alien authorized to work until
(See instructions)
(expiration date, if applicable, mm/dd/yyyy):
(Alien Registration Number/USCIS Number):
Some aliens may write "N/A" in the expiration date field.
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.
I attest, under penalty of perjury, that I am (check one of the following boxes):
Aliens authorized to work must provide only one of the following document numbers to complete Form I-9:
An Alien Registration Number/USCIS Number OR Form I-94 Admission Number OR Foreign Passport Number.
1. Alien Registration Number/USCIS Number:
2. Form I-94 Admission Number:
3. Foreign Passport Number:
Country of Issuance:
OR
OR
QR Code - Section 1
Do Not Write In This Space
Signature of Employee
Today's Date (mm/dd/yyyy)
Preparer and/or Translator Certification (check one):
I did not use a preparer or translator. A preparer(s) and/or translator(s) assisted the employee in completing Section 1.
(Fields below must be completed and signed when preparers and/or translators assist an employee in completing Section 1.)
I attest, under penalty of perjury, that I have assisted in the completion of Section 1 of this form and that to the best of my
knowledge the information is true and correct.
Signature of Preparer or Translator
Today's Date (mm/dd/yyyy)
Last Name (Family Name)
First Name (Given Name)
Address (Street Number and Name)
City or Town
State
ZIP Code
Employer Completes Next Page
Form I-9 10/21/2019
Page 2 of 3
USCIS
Form I-9
OMB No. 1615-0047
Expires 10/31/2022
Employment Eligibility Verification
Department of Homeland Security
U.S. Citizenship and Immigration Services
Section 2. Employer or Authorized Representative Review and Verification
(Employers or their authorized representative must complete and sign Section 2 within 3 business days of the employee's first day of employment. You
must physically examine one document from List A OR a combination of one document from List B and one document from List C as listed on the "Lists
of Acceptable Documents.")
Last Name (Family Name) M.I.
First Name (Given Name)
Employee Info from Section 1
Citizenship/Immigration Status
List A
Identity and Employment Authorization
Identity
Employment Authorization
OR List B AND List C
Additional Information
QR Code - Sections 2 & 3
Do Not Write In This Space
Document Title
Issuing Authority
Document Number
Expiration Date (if any) (mm/dd/yyyy)
Document Title
Issuing Authority
Document Number
Expiration Date (if any) (mm/dd/yyyy)
Document Title
Issuing Authority
Document Number
Expiration Date (if any) (mm/dd/yyyy)
Document Title
Issuing Authority
Document Number
Expiration Date (if any) (mm/dd/yyyy)
Document Title
Issuing Authority
Document Number
Expiration Date (if any) (mm/dd/yyyy)
Certification: I attest, under penalty of perjury, that (1) I have examined the document(s) presented by the above-named employee,
(2) the above-listed document(s) appear to be genuine and to relate to the employee named, and (3) to the best of my knowledge the
employee is authorized to work in the United States.
The employee's first day of employment (mm/dd/yyyy):
(See instructions for exemptions)
Today's Date (mm/dd/yyyy)
Signature of Employer or Authorized Representative
Title of Employer or Authorized Representative
Last Name of Employer or Authorized Representative
First Name of Employer or Authorized Representative
Employer's Business or Organization Name
Employer's Business or Organization Address (Street Number and Name)
City or Town
State
ZIP Code
Section 3. Reverification and Rehires (To be completed and signed by employer or authorized representative.)
A. New Name (if applicable)
Last Name (Family Name)
First Name (Given Name)
Middle Initial
B. Date of Rehire (if applicable)
Date (mm/dd/yyyy)
Document Title Document Number
Expiration Date (if any) (mm/dd/yyyy)
C. If the employee's previous grant of employment authorization has expired, provide the information for the document or receipt that establishes
continuing employment authorization in the space provided below.
I attest, under penalty of perjury, that to the best of my knowledge, this employee is authorized to work in the United States, and if
the employee presented document(s), the document(s) I have examined appear to be genuine and to relate to the individual.
Signature of Employer or Authorized Representative
Today's Date (mm/dd/yyyy)
Name of Employer or Authorized Representative
College of Southern Idaho
315 Falls Avenue
Twin Falls
Id
83301
LISTS OF ACCEPTABLE DOCUMENTS
All documents must be UNEXPIRED
Employees may present one selection from List A
or a combination of one selection from List B and one selection from List C.
LIST A
2. Permanent Resident Card or Alien
Registration Receipt Card (Form I-551)
1. U.S. Passport or U.S. Passport Card
3. Foreign passport that contains a
temporary I-551 stamp or temporary
I-551 printed notation on a machine-
readable immigrant visa
4. Employment Authorization Document
that contains a photograph (Form
I-766)
5. For a nonimmigrant alien authorized
to work for a specific employer
because of his or her status:
Documents that Establish
Both Identity and
Employment Authorization
6. Passport from the Federated States
of Micronesia (FSM) or the Republic
of the Marshall Islands (RMI) with
Form I-94 or Form I-94A indicating
nonimmigrant admission under the
Compact of Free Association Between
the United States and the FSM or RMI
b. Form I-94 or Form I-94A that has
the following:
(1) The same name as the passport;
and
(2) An endorsement of the alien's
nonimmigrant status as long as
that period of endorsement has
not yet expired and the
proposed employment is not in
conflict with any restrictions or
limitations identified on the form.
a. Foreign passport; and
For persons under age 18 who are
unable to present a document
listed above:
1. Driver's license or ID card issued by a
State or outlying possession of the
United States provided it contains a
photograph or information such as
name, date of birth, gender, height, eye
color, and address
9. Driver's license issued by a Canadian
government authority
3. School ID card with a photograph
6. Military dependent's ID card
7. U.S. Coast Guard Merchant Mariner
Card
8. Native American tribal document
10. School record or report card
11. Clinic, doctor, or hospital record
12. Day-care or nursery school record
2. ID card issued by federal, state or local
government agencies or entities,
provided it contains a photograph or
information such as name, date of birth,
gender, height, eye color, and address
4. Voter's registration card
5. U.S. Military card or draft record
Documents that Establish
Identity
LIST B
OR AND
LIST C
7. Employment authorization
document issued by the
Department of Homeland Security
1. A Social Security Account Number
card, unless the card
includes one of
the following restrictions:
2. Certification of report of birth issued
by the Department of State (Forms
DS-1350, FS-545, FS-240)
3. Original or certified copy of birth
certificate issued by a State,
county, municipal authority, or
territory of the United States
bearing an official seal
4. Native American tribal document
6. Identification Card for Use of
Resident Citizen in the United
States (Form I-179)
Documents that Establish
Employment Authorization
5. U.S. Citizen ID Card (Form I-197)
(2) VALID FOR WORK ONLY WITH
INS AUTHORIZATION
(3) VALID FOR WORK ONLY WITH
DHS AUTHORIZATION
(1) NOT VALID FOR EMPLOYMENT
Page 3 of 3
Form I-9 10/21/2019
Examples of many of these documents appear in the Handbook for Employers (M-274).
Refer to the instructions for more information about acceptable receipts.
Office of Human Resources
315 Falls Ave Twin Falls, ID 83301
(208)732-6271
hr.csi.edu
To the Authorized Representative:
Since the U.S. Citizenship and Immigration Services (USCIS) require us to verify the right of our
employees to work in the U.S., we are asking you to serve as our representative in this matter by
completing the attached I-9 Form.
IMPORTANT NOTE: for specific instructions on how to complete the I-9 for foreign nationals hired to
work at CSI or for any other questions, please refer to the attached instructions or contact one of our
Human Resource staff.
Lyntessa Limas
HR Generalist
(208) 732-6271
tlimas@csi.edu
Pam O'Dell
Benefits Coordinator
(208) 732-6206
podell@csi.edu
Please follow the instructions below to complete the I-9 for U.S. Citizens.
1. Review the I-9, instructions and list of acceptable documents, prior to beginning.
2. The employee must complete Section 1, including signature and date. Review the information to
make sure everything is filled in correctly. If changes need to be made have the employee draw
a line through the mistake, make the correction, and initial it.
3. Thoroughly review and photocopy (ensure copies are easily legible) the original documents the
employee presents from the “Lists of Acceptable Documents” (pg. 9):
One original document from List A
OR
Two original documents: one from List B (Identity) and one from List C (Work Eligibility).
IMPORTANT: No expired documents can be accepted. Do not accept faxes or
photocopies of any documents or laminated social security cards. The name on List B
and List C documents must match (with the exception of Birth Certificates for married
individuals).
4. Complete Section 2: Employer Review and Verification. Please be sure to include: last name, first
name, and middle initial as entered in Section 1. Document(s) title, issuing authority, document
number and expiration date. Note: If entering information for a Social Security Card (List C)
enter N/A in the expiration field.
5. Complete Certification Section:
a. Sign authorized representative section with: employee’s start date and date you verify
the documents (enter as mm/dd/yyyy), signature, title, and your printed name. Do not
notarize the I-9.
Enclosed please find the original I-9 Form, the lists of acceptable documents and instructions for
completion of the form. Form I-9 and instructions also are available online: www.uscis.gov/files/form/i-
9.pdf Thank you for accepting this commission. (Rev: 8/2020)
Direct Deposit Authorization
Savings
Savings
Checking
Checking
Account #1
Direct Deposit Bank Name
Account #2
Direct Deposit Bank Name
Signature__________________________________ Date________________
Attach a voided check here.
Deposit slips NOT accepted.
This Authorization will be in effect until CSI receives a written notice asking that the direct deposit be inactivated.
For remaining balance
Percent or fixed amount
_____%
$
_____
Employee Legal Name (Print)
Employee ID# or SSN
Contact telephone number
REQUIRED: Voided check/direct deposit statement from your bank with routing/account #.
Submit to HR Department.
Rev: 8/19
As an employee of the College of Southern Idaho, I acknowledge that I have been provided with the
Policy and Procedures Manual online handbook at hr.csi.edu/handbook/tofcmanual.htm and have
an opportunity to examine that document. I agree to familiarize myself with its contents and
comply with the information provided. I accept the responsibility to keep myself informed and
adhere to any future changes made to the Manual.
I
have read access to the Employee Performance Standards contained within the Policy and
Procedures Manual at hr.csi.edu/handbook/employment2.htm#performancestandards
with regard
to CSI’s Standard of Conduct and expectations for my workplace interactions, compliance to State
and Federal laws and rules, financial stewardship, and responsibility and accountability in my
service to the College.
The CSI Confidentiality Policy is intended to explain how we expect our employees to treat
confidential information. Employees may unavoidably receive and handle personal and private
information about students, employees, community members and our College. We want to make
sure that this information is well-protected because it may be legally binding; i.e., sensitive student
or employee data and/or constitute policy that is related to higher education or our college
specifically. Please find http://hr.csi.edu/handbook/procedures6.htm#Confidentiality in the Policy and
Procedures Manual and sign below to acknowledge that you will adhere to this policy.
As a faculty member, I acknowledge that I have been provided with access to the Faculty Handbook
at hr.csi.edu/facultyhandbook and an opportunity to examine this document. I agree to familiarize
myself with its contents and comply with the information provided. I accept the responsibility to
keep myself informed and adhere to any future changes made to the Handbook.
I
understand the College’s Policy and Procedures Manual does not constitute a contract of
employment between me and the College. Hard copies are available upon request.
______________________________________
PRINTED EMPLOYEE NAME
______________________________________
SIGNATURE OF EMPLOYEE
______________________________________
DATE
Copy: Employee and Personnel File
Rev: 1/2020
Return completed form to HR Department
Handbooks & Performance Standards
Employee Acknowledgement &
Certification of Understanding
This page is intended to be blank.
As an employee of the College of Southern Idaho, I acknowledge that I have been provided with the
Policy and Procedures Manual online handbook at hr.csi.edu/handbook/tofcmanual.htm and have
an opportunity to examine that document. I agree to familiarize myself with its contents and
comply with the information provided. I accept the responsibility to keep myself informed and
adhere to any future changes made to the Manual.
I
have read access to the Employee Performance Standards contained within the Policy and
Procedures Manual at hr.csi.edu/handbook/employment2.htm#performancestandards
with regard
to CSI’s Standard of Conduct and expectations for my workplace interactions, compliance to State
and Federal laws and rules, financial stewardship, and responsibility and accountability in my
service to the College.
The CSI Confidentiality Policy is intended to explain how we expect our employees to treat
confidential information. Employees may unavoidably receive and handle personal and private
information about students, employees, community members and our College. We want to make
sure that this information is well-protected because it may be legally binding; i.e., sensitive student
or employee data and/or constitute policy that is related to higher education or our college
specifically. Please find http://hr.csi.edu/handbook/procedures6.htm#Confidentiality in the Policy and
Procedures Manual and sign below to acknowledge that you will adhere to this policy.
As a faculty member, I acknowledge that I have been provided with access to the Faculty Handbook
at hr.csi.edu/facultyhandbook and an opportunity to examine this document. I agree to familiarize
myself with its contents and comply with the information provided. I accept the responsibility to
keep myself informed and adhere to any future changes made to the Handbook.
I
understand the College’s Policy and Procedures Manual does not constitute a contract of
employment between me and the College. Hard copies are available upon request.
______________________________________
PRINTED EMPLOYEE NAME
______________________________________
SIGNATURE OF EMPLOYEE
______________________________________
DATE
Copy: Employee and Personnel File
Rev: 1/2020
Return completed form to HR Department
Handbooks & Performance Standards
Employee Acknowledgement &
Certification of Understanding
EMPLOYEE COPY
This page is intended to be blank.
New
Health Insurance Marketplace Coverage
Options
and Your
Health Coverage
PART A: General
Information
When key parts of the health care law take effect in 2014, there will be a new way to buy health insurance
:
the Health
Insurance Marketplace. To assist you as you evaluate options for you and your family, this notice provides some basic
information about the new Marketplace and employmentbased health coverage offered by your employer.
What is the Health Insurance Marketplace?
The Marketplace is designed to help you find health insurance that meets your needs and fits your budget. The
Marketplace offers "one-stop shopping" to find and compare private health insurance options. You may also be eligible
for a new kind of tax credit that lowers your monthly premium right away. Open enrollment for health insurance
coverage through the Marketplace begins in October 2013 for coverage starting as early as January 1, 2014.
Can I Save Money on my Health Insurance Premiums in the Marketplace?
You may qualify to save money and lower your monthly premium, but only if your employer does not offer coverage, or
offers coverage that doesn't meet certain standards. The savings on your premium that you're eligible for depends on
your household income.
Does Employer Health Coverage Affect Eligibility for Premium Savings through the Marketplace?
Yes. If you have an offer of health coverage from your employer that meets certain standards, you will not be eligible for
a tax credit through the Marketplace and may wish to enroll in your employer's health plan. However, you may be
eligible for a tax credit that lowers your monthly premium, or a reduction in certain cost-sharing if your employer does
not offer coverage to you at all or does not offer coverage that meets certain standards. If the cost of a plan from your
employer that would cover you (and not any other members of your family) is more than 9.5% of your household income
for the year, or if the coverage your employer provides does not meet the "minimum value" standard set by the
Affordable Care Act, you may be eligible for a tax credit.
1
Note:
If you purchase a health plan through the Marketplace instead of accepting health coverage offered by your
employer, then you may lose the employer contribution (if any) to the employer-offered coverage. Also, this employer
contribution -as well as your employee contribution to employer-offered coverage- is often excluded from income for
Federal and State income tax purposes. Your payments for coverage through the Marketplace are made on an after-tax
basis.
How Can I Get More Information?
For more information about your coverage offered by your employer, please check your summary plan description or
contact
.
The Marketplace can help you evaluate your coverage options, including your eligibility for coverage through the
Marketplace and its cost. Please visit
HealthCare.gov
for more information, including an online application for health
insurance coverage and contact information for a Health Insurance Marketplace in your area.
1
An
employer-sponsored health plan meets the "minimum value standard"
if the
plan's
share of
the total allowed benefit costs covered
by
the plan
is no less
than 60 percent
of
such costs.
Form Approved
OMB No. 1210-0149
(expires 6-30-2023)
Pam O'Dell 208-732-6206
PART B: Information About Health Coverage Offered by Your Employer
This section contains information about any health coverage offered by your employer. If you decide to complete an
application for coverage in the Marketplace, you will be asked to provide this information. This information is numbered to
correspond to the Marketplace application.
3.
Employer name
4.
Employer Identification Number (EIN)
5.
Employer address
6.
Employer phone number
7.
City
8.
State
9. ZIP
code
10.
Who can we contact about employee health coverage at this job?
11. Phone number (if different from above) 12. Email address
Here is some basic information about health coverage offered by this employer:
•
As your employer, we offer a health plan to:
All employees. Eligible employees are:
Some e
mployees. Eligible employees are:
•
With respect to dependents:
We do offer coverage. Eligible dependents are:
We do not offer coverage.
This coverage meets the minimum value standard, and the cost of this coverage to you is intended to be
affordable, based on employee wages.
** Even if your employer intends your coverage to be affordable, you may still be eligible for a premium discount
through the Marketplace. The Marketplace will use your household income, along with other factors, to
determine whether you may be eligible for a premium discount. If, for example, your wages vary from week to
week (perhaps you are an hourly employee or you work on a commission basis), if you are newly employed
mid-year, or if you have other income losses, you may still qualify for a premium discount.
If you decide to shop for coverage in the Marketplace,
HealthCare.gov
will guide you through the process. Here's the
employer information you'll enter when you visit
HealthCare.gov
to find out if you can get a tax credit to lower your
monthly premiums.
College of Southern Idaho
82-0261628
PO Box 1238
208-732-6206
Twin Falls
Idaho
83301
Pam O'Dell
208-732-6206
podell@csi.edu
x
Employees working twenty or more hours per week for a five-month period become eligible
for insurance.
x
Legally married spouses and all children, step-children, or children for which you have legal
guardianship under age 26 are eligible for coverage.
CSI Notice
We are providing this notice in accordance with Federal Law. We cannot provide you with further information about its
content or assist you in evaluating your optionsnge coverage or the potential penalties under law.
Employee Signature ____________________________________________________Date _______________________________
APPLICATION FOR EMPLOYMENT
1. APPL
ICANT DATA
Position applying for:
Name
Mailing Address City State Zip
Telephone Cellular Email Address
Police Record: Have you ever been convicted of, or entered a plea of guilty or no contest, or had a withheld judgment to a
felony? Yes No (If yes, give date, offense and outcome of each violation.)
2. EDUCATIONAL DATA
Name and location of school(s)
List Diploma,
Degree or GED
Degree
completed?
Major or principal
courses studied
High School/equivalency
Yes No
College
Yes No
Trade, Business, Military,
Night School, Other
Yes
No
3. EMPLOYMENT DATA (Employment data for recent positions must be fully documented.)
JOB TITLE & COMPANY NAME of most recent employer
Telephone Number
Address City State Zip
Immediate Supervisor
Date Hired
Date Left
Reason for Leaving
May we contact the employer? Yes No
JOB TITLE & COMPANY NAME of previous employer
Telephone Number
Address City State Zip
Immediate Supervisor
Date Hired
Date Left
Reason for Leaving
May we contact the employer? Yes No
JOB TITLE & COMPANY NAME of previous employer
Telephone Number
Address City State Zip
Immediate Supervisor
Date Hired
Date Left
Reason for Leaving
May we contact the employer? Yes No
I certify the information supplied by me in this application is true and correct and I authorize investigation of all statements
including former employers and references. I understand that any misrepresentation or omission of facts by me in this
application is cause for my discharge in the event I am hired. The employment relationship with the College of Southern Idaho
is based on the mutual consent of the employee and employer. The relationship can be terminated at will any time. (4/18)
SIG
NATURE ____________________________________________ DATE ___________________________
The Co
llege of Southern Idaho is an equal opportunity employer and a drug and alcohol-free workplace.
315 Falls Ave PO Box 1238 Twin Falls ID 83303 208-732-6269 Fax: 208-732-6678 www.csi.edu/jobs
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