CiscoCollegeJanuary2015
PartTime
NonStudent
NewHire
Packet
(AcademicYear201920)
New Employee Information
Title:
Last Name:
First Name:
Social Security #
Address:
City,State,Zip:
Home Phone:
Cell Phone:
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
____________________________________________
Cisco College IT Acceptable Use Policy:
Yes, I have read the Cisco College IT Acceptable
Use Policy.
Policy is available at: http://www.cisco.edu/
s/926/images/editor_documents/hr_forms/
ciscocollegepolicymanual-spring2016.pdf
Full Time Part Time
Primary Location
Cisco Abilene
FT/PT
PayCheck Disbursement:
I will pick up my check in Abilene
I will pick up my check in Cisco
I have Direct Deposit:
(please specify mail or pick up for first check)
Mail my paycheck to the following address:
__________________________________
__________________________________
__________________________________
_________________________________________________________________________________
____________________________________________________________________________________________________________
_________________________________________________________________________________
____________________________________________________________________________________________________________
(Click link above to view Policy)
Emergency Contact Person:
Relationship to Emergency Contact:
Emergency Contact Address:
Emergency Contact City, State, Zip:
________________________________________
__________________________________
_______________________________________
__________________________________
Emergency Contact Home phone: ____________________________________
Emergency Contact Work Phone: ____________________________________
Emergency Contact Cell Phone: _____________________________________
Highest Degree Earned:
Ethnicity:
Employee Classification:
Home Phone Available to Students: Yes
No
Home Email Available to Students:
Yes
No
Employee Signature: _________________________________Date: ____________________
_________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
_________________________________________________________________________________
Job Title:______________________________________________________
Faculty Position:
Division:
Hire Date: _____________________________
Home Email: ___________________________________________________
____________________
__________________________
______________________________
_____________________________
______________________________
BIOGRAPHIC REPORT
NAME:______________________________________________________________________
ADDRESS:__________________________________________________________________
Street City State Zip
Telephone Number:____________________________________________________________
Social Security Number:________________________________________________________
Highest Degree or Certificate:____________________________________________________
Institution of Highest Degree:____________________________________________________
Area of Specialization:__________________________________________________________
Date of Birth:_________________________________________________________________
Total Teaching Experience:______________________________________________________
Date of Employment:___________________________________________________________
Job Title:____________________________________________________________________
Teaching Experience at Cisco College:_____________________________________________
Teaching Experience other than Cisco College:______________________________________
Ethnic origin – Please check only one:
American-Indian/Alaskan Native _______
Asian _______
Black _______
Hispanic _______
White _______
Other _______ Date:__________________
PART-TIME EMPLOYEE
RETIREMENT INFORMATION (TRS)
*** This
form MUST BE Completed!! ***
SOCIAL SECURITY NUMBER_________________________________________
LAST NAME________________________________________________________
FIRST NAME___________________________MIDDLE INITIAL_______________
1. Have you ever worked for a TRS-covered employer*?
YES__________NO___________
*State supported universities, medical and dental schools, junior/community colleges, public
schools, regional education service centers, certain charter schools
If NO
, please fill out the “Part-Time Employee Retirement Selection Form” to choose
between MetLife (FICA Alternative Plan) and enrollment form OR Social Security.
2. Did you contribute to TRS during this period of employment?
YES_________ NO__________
3. If the answer to #2 is yes, have you withdrawn your funds from TRS?
YES_________ NO__________
4. If the answer to #2 is NO, do you receive a monthly retirement check from TRS? (If
the answer is YES (I do receive a retirement check).
YES_________ NO__________
If YES, Retirement Date _____________________
5. Are you currently employed by another TRS-covered employer?
YES_____ NO_____ If YES, is it full or part time? FULL______ PART _______
Employer’s Name? __________________________________________________
PART-TIME EMPLOYEE
RETIREMENT SELECTION FORM
*** (This form MUST be completed!!)***
1. _________ MetLife
In consideration of my employer’s obligations under the Cisco College Tax Sheltered Annuity
Plan (the “Plan”), I hereby elect to defer 6.2% of total Compensation (as defined in the Plan) for
services rendered after the date of this Salary Reduction Agreement. I hereby authorize my
employer to effect such deferrals by payroll deduction each pay period. In making this election, I
understand that my deferrals are being made on a before tax basis which means I am agreeing to
have my Compensation reduced by the states percentages and, in turn my employer will
contribute my Compensation reduction amounts to the Plan on my behalf, and such amounts will
be applied toward the premiums payable on the annuity contract obtained for me pursuant to the
Plan. I also understand that my employer has a right to reduce my elected percentage as may be
legally required in order to comply with section 403(b) and any and all other sections of the
Internal Revenue Code. I further understand that I may not change my elected percentage nor
revoke this Salary Reduction Agreement at any time prior to termination of my employment with
my employer.
2. _______ Social Security
OR
3. _______ Teachers Retirement System of Texas
(Only available to part-time employees who are concurrently employed
full-time with TRS-eligible employer – As indicated on completion of
TRS Retirement Form.)
____________________________________
Signature of Participant Date
____________________________________
Participant’s Name Please Print
CISCO COLLEGE
____________________________________
Agreed to by Employer Date
Cisco College
Annuity/Non-Erisa
1008792
Fax: 732-893-6414
6.2
Employer Information
1. Federal Employer ID Number (FEIN): 2. State Employer ID Number (Optional):
Please use the same FEIN that appears on quarterly wage reports.
3. Employer Name:
4. Employer Address (Please indicate the address where the Income Withholding Orders should be sent):
5. Employer City (if US): 6. State (if US): 7. ZIP Code (if US):
_
8. Province/Region (if foreign): 9. Country (if foreign): 10. Postal Code (if foreign):
11. Employer Telephone (Optional): 12. Employer FAX (Optional):
13. New Hire Contact Person (Optional):
Employee Information
14. Social Security Number (SSN): 15. Date of Hire (MM/DD/YYYY):
16. Employee First Name:
17. Employee Middle Name:
18. Employee Last Name:
19. Employee Home Address:
20. Employee City (if US): 21. State (if US): 22. ZIP Code (if US):
_
23. Province/Region (if foreign): 24. Country (if foreign): 25. Postal Code (if foreign):
26. State Where Employee Was Hired (Optional): 27. Employee DOB (MM/DD/YYYY) (Optional):
28. Employee’s Salary (Dollars and Cents) (Optional):
29. Salary Frequency (Check One ONLY) (Optional):
Hourly
Weekly
Biweekly
Semi-Monthly
Monthly
Annually
Texas Employer New Hire Reporting Form
Submit within 20 calendar days of new employee’s
first day of work to:
ENHR Operations Center, P.O. Box 149224
Austin, TX 78714-9224
Phone: 1-800-850-6442 FAX: 1-800-732-5015
Online: www.employer.texasattorneygeneral.gov
To ensure the highest level of accuracy, please print neatly
in capital letters and avoid contact with the edges of the
boxes. The following will serve as an example:
A
B
C
1
2
3
REV 12/13 ENHR RPT FORM
7 5 1 1 6 4 3 4 3
C I S C O C O L L E G E
1 0 1 C O L L E G E H E I G H T S
C I S C O
T X
7 6 4 3 7
2 5 4 4 4 2 5 1 2 1
76437
INSTRUCTIONS FOR COMPLETING THE TEXAS EMPLOYER NEW HIRE REPORTING FORM
The purpose of the Texas New Hire Reporting Form is to allow employers to fulfill new hire reporting requirements. You may enter your
employer information and photocopy a supply and then enter employee information on the copies.
REPORTING OF NEW HIRES IS REQUIRED:
All required items (numbers 1, 3, 4, 5, 6, 7, 14, 15, 16, 17, 18, 19, 20, 21, 22) on this form must be completed.
Box 1: Federal Employer ID Number (FEIN). Provide the 9-digit employer identification number that the federal government assigns to the
employer. This is the same number used for federal tax reporting. Please use the same FEIN that appears on quarterly wage reports.
Box 2: State Employer ID Number (Optional). Identification number assigned to the employer by the Texas Workforce Commission.
Box 3: Employer Name. The employer name as listed on the employee’s W4 form. Please do not provide more than one employer name
(for example, “ABC, Inc DBA. John Doe Paint and Body Shop” is not correct).
Box 4: Employer Address. Please indicate the address where the Income Withholding Orders should be sent. Do not provide more
than one address (for example, P.O. Box 123, 1313 Mockingbird Lane is not correct).
Box 8: Employer Province/Region (if foreign). Provide this information if the employer address is not in the United States.
Box 9: Employer Country (if foreign). Provide the two letter country abbreviation if the employer address is not in the United States.
Box 10: Postal Code (if foreign). Provide the postal code if the employer address is not in the United States.
Box 13: New Hire Contact Person (Optional). Providing the name of a contact staff person will facilitate communication between the
employer and the Texas Employer New Hire Reporting Program.
Box 15: Date of Hire. List the date in month, day and year order. Use four digits for the year (for example, 2001). This should be the first
day that services are performed for wages by an individual. If you are reporting a rehire (where a new W-4 is prepared) use the return date,
not the original date of hire.
Box 23: Employee Province/Region (if foreign). Provide this information if the employee does not reside in the United States.
Box 24: Employee Country (if foreign). Provide the two letter country abbreviation if the employee address is not in the United States.
Box 25: Postal Code (if foreign). Provide the postal code if the employee address is not in the United States.
Box 26: State Where Employee was Hired. Use the abbreviation recognized by the U.S. Postal Service for the state in which the
employee was hired.
Box 27: Employee DOB (Date of Birth) (Optional). List the date in month, day and year order. Use four digits for the year (for example,
1985).
Box 28: Employee Salary (Optional). Enter employee’s exact wages in dollars and cents. This should correspond to the salary pay
frequency indicated in Box 29.
Box 29: Salary (Check One ONLY) (Optional). Check the appropriate box relating to the employee’s salary pay frequency. Check “ Bi-
weekly” if the salary is based on 26 pay periods. Check “Semi-monthly” if the salary is based on 24 pay periods. Check “Annually” if salary
payment is a one-time distribution.
SUBMISSION OF NEW HIRE REPORTS. The Texas Employer New Hire Reporting Program offers a variety of methods that employers
can use to submit new hire reports. For further information on which method may be best for you, call 1-800-850-6442. Employers are
encouraged to keep photocopies or electronic records of all reports submitted. When the form is completed, send it to the Texas Employer
New Hire Reporting Program using one of the following means:
FAX: 1-800-732-5015
U.S. Mail:
ENHR Operations Center
P.O. Box 149224
Austin, TX 78714-9224
Telephone Submissions: 1-800-850-6442
Internet Submissions: www.employer.texasattorneygeneral.gov
Employers must provide all of the required information within 20 calendar days of the employee's first day of work to be in
compliance. State law provides a penalty of $25 for each employee an employer knowingly fails to report, and a penalty of $500 for
conspiring with an employee to 1) fail to file a report or 2) submit a false or incomplete report.
REV 12/13 ENHR RPT FORM
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)
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 1(a), 1(b), 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 7.5% 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 Part II of 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
USCIS
Form I-9
OMB No. 1615-0047
Expires 08/31/2019
Employment Eligibility Verification
Department of Homeland Security
U.S. Citizenship and Immigration Services
Form I-9 07/17/17 N
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)
U.S. Social Security Number
-
-
Employee's E-mail Address
Employee's Telephone Number
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):
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.
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
C I S C O
Form I-9 07/17/17 N
Page 2 of 3
USCIS
Form I-9
OMB No. 1615-0047
Expires 08/31/2019
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)
Signature of Employer or Authorized Representative
Today's Date (mm/dd/yyyy)
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
Cisco College
101 College Heights
Cisco
TX
76437
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 07/17/17 N
Examples of many of these documents appear in Part 13 of the Handbook for Employers (M-274).
Refer to the instructions for more information about acceptable receipts.
EMPLOYEE HANDBOOK
I verify that I will read the Cisco College Employee Handbook. The handbook is
located on the Cisco College Website/Intranet at:
http://csacs01/policy/default.aspx
___________________________
Signature of Employee
___________________________
Date
DIRECT DEPOSIT AUTHORIZATION FORM
Name:_______________________________________________________________________
Last Name First Name MI
SSN:____________________________________
Payroll Type:
Semi-Monthy Monthly
______START: I authorize you and the financial institution listed below to deposit my
net pay automatically to my account(s) each payday, and to initiate adjustments, if
necessary, for any entries made in error to my accounts.
______CHANGE Checking and/or Savings: I authorize you to change my direct deposit
to the account(s) at the financial institution listed below.
______STOP: I authorize you to stop the direct deposit of my net paycheck.
Institution Name__________________________ ________% of net check or $___________
Account Type: _____Checking _____Savings Account Number: _______________________
Bank Routing /Transit Number: ___ ___ ___ ___ ___ ___ ___ ___ ___
Signature: _______________________________________ Date: ___________________
Shaded Area for Payroll Use Only
Received
Prenoted Deposited
A VOIDED CHECK MUST BE PROVIDED IN THE SPACE BELOW
Routing/Transit Number -
Routing/Transit is a 9
-digit
number that identifies the
financial institution where
your checking account is
located.
Account Number - This is
your checking account
number.
Check Number - The financial institution scans the
check number electronically
in order for it to appear on
your monthly statement.
DIRECT DEPOSIT INFORMATION
1. The payroll deposit authorized by the employee’ signature on the Direct Deposit
Authorization form is accomplished by a process known as electronic funds transfer. It is
covered by a number of Federal regulations designed to safeguard the integrity of the
employee’s account
2. The funds deposited should be available to the employee for withdrawal by all regular
means on the morning of the scheduled payday.
3. The electronic funds transfer system requires an additional step known as pre-
notification. This is a procedure whereby account numbers must be verified by the
receiving financial institution before we will transmit direct deposit data to them.
Therefore new authorizations, changes, or cancellations should be in the Payroll
Department one month prior to the month the authorization, change or cancellation is to
take effect. If the authorization cannot be processed, Payroll will notify the employee,
who will continue to receive a payroll check until the authorization can be processed.
4. The pre-notification process also dictates that if a change in the financial institution or
account number is made, the employee must be removed from direct deposit for a
minimum of one pay period before the change will take effect. For the payday(s) the
employee will receive a payroll check(s).
5. Cisco College assumes no responsibility to issue a payroll check to any employee whose
direct deposit could not be processed due to his/her account being closed, or any other
reason, until the receiving financial institution has either refunded or guaranteed refund
of such deposit to the College.
RETURN
COMPLETED FORM TO:
Cisco College
Human Resources Office
101 College Heights
Cisco, TX 76437
EEO Training Acknowledgment
I have received notification from Human Resources of the requirement to complete EEO Training as a
new employee of Cisco College. I understand that within 30 days of employment, I must complete
the training, print a certificate, and provide a copy of the completion certificate to the Human
Resources Office. I understand that I will have to re-certify this training every two years, if still
employed with Cisco College. I also understand that the link to take the course may be accessed by
me as indicated below:
You may select the link below:
https://www.softchalkcloud.com/lesson/serve/XAU6OjCIblu1z5/html
OR
Go to the Cisco College website (www.cisco.edu).
Select “Faculty & Staff” link
Under “Human Resources,” select “EEO Training” link
You will be at the Login Prompt for the EEO Training Course.
I
have also been provided a copy of the EEO Training Instructions to assist me in completing the
training.
____
__________________________________ ________________________________
Name Date
July 2014
EEO Training Instructions
All Cisco College employees (full-time/part-time) are required by law to complete the Equal
Employment Opportunity Training upon initial employment and every two years thereafter. An
updated Computer Based Training (CBT) has been made available to us by the Texas Workforce
Commission. Please be prompt about completing this required training. Upon completion please
send a copy of your certificate to the HR Office
. Your EEO training completion date is tracked in your
Payroll System Record, and a copy is filed in your personnel file.
Y
ou will be reminded via email four weeks prior to your 2-year completion date so you will have
sufficient time to take the course again and submit your new Completion Certificate by the 2-year
mark from your previous training.
To Take the EEO Training
:
1. Ensure your computer has Adobe Flash loaded.
2. You may select the link below:
https://www.softchalkcloud.com/lesson/serve/XAU6OjCIblu1z5/html
OR
3. Go to the Cisco College website (www.cisco.edu).
Select “Faculty & Staff” link
Under “Human Resources,” select “EEO Training” link
You will be at the Login Prompt for the EEO Training Course.
4. Login Information is as follows:
You will be prompted to enter your work email address
This will take you directly into the course
5. You can stop the course to go back to finish it at a later date. However, you cannot start the
c
ourse over again or change previously completed answers. The course will simply pick up at
the point you stopped.
6. When you are prompted at the end of the course to enter your “Agency Code,” you should
enter “Cisco College & Your name,” (EX: Cisco College - Pam Page). This information will be
used for your completion certificate. Select “Print Certificate.” Once printed, then selec
t
Finish.” HR MUST HAVE A COPY OF YOUR CERTIFICATE IN ORDER TO GIVE YOU CREDIT
FOR COMPLETING THE COURSE.
7. IMPORTANT INFO ONLY IF YOU ARE UNABLE TO PRINT A CERTIFICATE: If you are unable to print a
certificate (very rare occurrence), be sure to write down the “Completion Number,” and email it to
the HR Office. You must have the Completion Number in order to prove successful completion of t
he
c
ourse to request a printed certificate. HR must receive a copy of the certificate to credit you wit
h
c
ompletion of the course.
July 2014
Veteran Status
The following request for information is used for reporting purposes and to obtain
information for the Veteran Workforce Summary Report. The Veteran Workforce Summary
Report compiles and analyzes information on the hiring and employment of veterans by
Texas state agencies and institutions of higher education, including public community and
junior colleges.
___ I am not a Veteran ___ Disabled Veteran ___ I am a Veteran
Are you an orphan of a veteran, if veteran was killed while on active duty? YES NO
Are you a surviving spouse of a veteran (who has not remarried)? YES NO
Employee Signature __________________________ Date______________