Fillable STUDENT EMPLOYMENT PACKET (Foothill College)

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STUDENT EMPLOYMENT PACKET (Foothill College)

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STUDENT EMPLOYEE INFORMATION SHEET
1. Employee Information
Social Security #
Date of Birth
(mm/dd/yyyy)
Middle Last
(Print your name as it appears on your Social Security card)
First Name
Email
Telephone
Address City/State/Zip
2. Person to contact in case of emergency
Name Relationship to Student
Address City/State/Zip
Telephone
3. Loyalty Oath(Required under Government Code Section 3102)
I, , do solemnly swear (or affirm) that I will support and defend the Constitution
of the United States and the Constitution of the State of California against all enemies, foreign or domestic; that I
will bear true faith and allegiance to the Constitution of the United States and the Constitution of the State of
California; that I take this obligation freely, without any mental reservation or purpose of evasion; and that I will
well and faithfully discharge the duties upon which I am about to enter.
Signature
Date
4. Relative Hiring
Do you have any relatives employed by the Foothill-De Anza Community College District? If yes, list below.
Name Dept College
5. Conviction Information
Have you ever been convicted of a crime? (You do not need to disclose convictions arising out of minor violations of
the Vehicle code, but you do need to disclose all misdemeanor and felony convictions, even those later set aside
under Penal code Section 1203.4) Convictions are not an automatic bar to employment.
Yes
No
If yes, please explain
Signature
Date
Page 1 of 6
STUDENT EMPLOYMENT PACKET
FOOTHILL COLLEGE FINANCIAL AID
foothill.edu/financialaid/
Stude
nt Services Building, 8100
Phone: 650.949.7245
Print your full name
BEFORE you fill out the form, DOWNLOAD the packet to your computer and complete as much
as you can using Acrobat Reader. Then PRINT (saving may delete your entries) the completed
document and SIGN in ink.
rev. 1/20
Page 2 of 6
NEW STUDENT EMPLOYEE CERTIFICATION PAGE
Signature
Date
FOR INTERNATIONAL STUDENTS ONLY
Please provide your FIRST entry date to the U.S. as an F1 visa holder.
Date
Signature
IMPORTANT: THIS STATEMENT IS REQUIRED TO BE RETAINED IN YOUR PERSONNEL FILE FOR STUDENT EMPLOYMENT
STUDENT EMPLOYMENT PACKET
FOOTHILL COLLEGE FINANCIAL AID
foothill.edu/financialaid/
Student Servic
es Building, 8100
Phone: 650.949.7245
By signing below, I certify that I have read and understand the information on district policies and
procedures regarding Paid Sick Leave for Part-time Employees, Drug-Free Work Place Policy,
Mandatory Reporter Obligations, Designation to Receive Warrants, and Injury and Illness Prevention
at:
foothill.edu/reg/forms/Student_Hire_Packet.pdf
I certify that I read and understand that I am obliged to follow these policies and guidelines in
my work activities.
Type name exactly as it appears on your Social Security Card:
First Name:
Middle Name:
Last Name:
Social Security Number (SSN):
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)
Full W-4 with instructions and worksheet: https://www.irs.gov/pub/irs-pdf/fw4.pdf
EMPLOYEE’S WITHHOLDING ALLOWANCE CERTIFICATE
1. Number of allowances for Regular Withholding Allowances, Worksheet A
Number of allowances from the Estimated Deductions, Worksheet B
Total Number of Allowances (A + B) when using the California
Withholding Schedules for 2019
OR
2. Additional amount of state income tax to be withheld each pay period (if employer agrees), Worksheet C
OR
3. I certify under penalty of perjury that I am not subject to California withholding. I meet the conditions set forth under
the Service Member Civil Relief Act, as amended by the Military Spouses Residency Relief Act. (Check box here)
Under the penalties of perjury, I certify that the number of withholding allowances claimed on this certificate does not exceed the
number to which I am entitled or, if claiming exemption from withholding, that I am entitled to claim the exempt status.
Signature Date
Employer’s Name and Address California Employer Payroll Tax Account Number
cut here
Give the top portion of this page to your employer and keep the remainder for your records.
YOUR CALIFORNIA PERSONAL INCOME TAX MAY BE UNDERWITHHELD IF YOU DO NOT FILE THIS DE 4 FORM.
IF YOU RELY ON THE FEDERAL FORM W-4 FOR YOUR CALIFORNIA WITHHOLDING ALLOWANCES, YOUR CALIFORNIA STATE
PERSONAL INCOME TAX MAY BE UNDERWITHHELD AND YOU MAY OWE MONEY AT THE END OF THE YEAR.
PURPOSE: This certificate, DE 4, is for California Personal Income
Tax (PIT) withholding purposes only. The DE 4 is used to compute
the amount of taxes to be withheld from your wages, by your
employer, to accurately reflect your state tax withholding obligation.
You should complete this form if either:
(1) You claim a different marital status, number of regular allowances,
or different additional dollar amount to be withheld for California PIT
withholding than you claim for federal income tax withholding or,
(2) You claim additional allowances for estimated deductions.
THIS FORM WILL NOT CHANGE YOUR FEDERAL
WITHHOLDING ALLOWANCES.
The federal Form W-4 is applicable for California withholding
purposes if you wish to claim the same marital status, number
of regular allowances, and/or the same additional dollar amount
to be withheld for state and federal purposes. However, federal
tax brackets and withholding methods do not reflect state PIT
withholding tables. If you rely on the number of withholding
allowances you claim on your Form W-4 withholding allowance
City, State, and ZIP Code
Home Address (Number and Street or Rural Route)
Type or Print Your Full Name Your Social Security Number
Filing Status Withholding Allowances
SINGLE or MARRIED (with two or more incomes)
MARRIED (one income)
HEAD OF HOUSEHOLD
certificate for your state income tax withholding, you may
be significantly underwithheld. This is particularly true if your
household income is derived from more than one source.
CHECK YOUR WITHHOLDING: After your Form W-4
and/or DE 4 takes effect, compare the state income tax withheld
with your estimated total annual tax. For state withholding, use
the worksheets on this form.
EXEMPTION FROM WITHHOLDING: If you wish to claim
exempt, complete the federal Form W-4. You may claim exempt
from withholding California income tax if you did not owe
any federal income tax last year and you do not expect to owe
any federal income tax this year. The exemption is good for
one year. If you continue to qualify for the exempt filing status,
a new Form W-4 designating EXEMPT must be submitted by
February 15 each year to continue your exemption. If you are not
having federal income tax withheld this year but expect to have
a tax liability next year, you are required to give your employer a
new Form W-4 by December 1.
DE 4 Rev. 47 (12-18) (INTERNET) CU
Full DE-4 form with instructions and worksheet:
https://foothill.edu/financialaid/programs/pdf/de4-12-18.pdf
Employee Acknowledgment of Responsibility for
Confidentiality of College Records and Computer Passwords
The security and confidentiality of student records are matters of concern to all college employees, including student
employees, and to any other persons having access to the information. Employees may be given access to college records,
including student and employee records, as warranted by their job responsibilities. Since conduct on and off campus may
affect or threaten the security and confidentiality of college records, each student employee is expected to adhere to the
following:
1. I will not permit access to or unauthorized use of any
information maintained, stored, or processed by any
office on the campus.
2. I will not seek personal benefit or allow others to benefit
personally from knowledge of any information regarding
college records that has come by virtue of my work
assignment.
3. I will not exhibit or divulge the contents of any college
records or report to any person except in the conduct of
my work assignment.
4. I will not knowingly include or cause to be included in
any records or reports a false, inaccurate, or misleading
entry. I also will not knowingly delete or cause to be
deleted any records, reports, or data entry.
5. I will not remove any official record or report (or copy
thereof) from the office where it is maintained except in
the performance of my work assignment.
6. I will not aid, abet, or act in conspiracy with another to
violate any part of this document.
7. I understand that district computer passwords are
confidential and are to be used by the assigned
employee only. I will not share, loan, or make known my
password to any other individual. I will log on under my
own password every time I access the system. When I
leave a computer workstation for any period of time
(lunch, breaks, meetings, etc.), I will log off of the
computer.
8. I will refer any requests for the release of information in
event of an emergency to my supervisor or manager.
I will refer any questions concerning the release of
information to my supervisor or manager.
State and Federal
law and college and District procedures prohibit the release of student records verbally, in writing, or by
any other means, without the written consent of the student, a court order, or a lawfully issued subpoena. (Family
Educational Rights and Privacy Act, PL 93-380; California Education Code §76200 et seq.; Title 5 California Code of
Regulations §54600 et seq.)
By my signature below, I acknowledge that I have received a copy of, have read, do understand, and will comply with this
Acknowledgement. I agree to protect the security and confidentiality of all college records, including those of students and
employees, and to prevent unauthorized or inappropriate disclosure of such records. I understand that violation of this
statement may lead to disciplinary action up to and including termination of my employment and may subject me to criminal
and civil penalties as imposed by law.
__________________
______________________________________ _________________________________
Employee Signature Date
________________________________________________________
Print Name
Page 5 of 6
THIS PAGE LEFT BLANK INTENTIONALLY
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
►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
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Completed 25 July 2020

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