Fillable Student Hiring Packet (University of Arkansas - Monticello)

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Student Hiring Packet (University of Arkansas - Monticello)

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Direct Deposit Acknowledgement
I understand that as a condition of employment, and in accordance with Operating Procedure
407.1, I must enroll and remain enrolled in direct deposit, or request an exemption from these
requirements due to hardship. A hardship exemption request can be made by contacting the
Office of Personnel at 870-460-1082. If I am a new hire or rehire, I understand I can go no
further in the hiring process until such request for exemption is reviewed.
Signature/Date Position
Name
University of Arkansas at
Monticello
Direct Deposit Authorization Form
UAM ID Number
Check One: New Enrollment Change Termination
Depositories:
Name of Financial Institution:
Bank Routing/Transit Number
/ / / / / / / / / /
City State Zip
Account Number
Checking
Savings
Percent or Partial Amount of
Net Pay per pay period to be
deposited
to
this
account:
(If you wish all net pay deposited to this account, enter 100%)
Name of Financial Institution:
Bank Routing/Transit Number
/ / / / / / / / / /
City State Zip
Account Number
Checking
Savings
Percent or Partial Amount of
Net Pay per pay period to be
deposited
to
this
account:
Name of Financial Institution:
Bank Routing/Transit Number
/ / / / / / / / / /
City State Zip
Account Number
Checking
Savings
Percent or Partial Amount of
Net Pay per pay period to be
deposited
to
this
account:
I hereby authorize the University of Arkansas at Monticello (UAM) to deposit to my account(s) the above net
amount(s). I also authorize UAM to initiate such debit entries to said account(s) as may be required to correct any
erroneous entries or make necessary adjustments.
I acknowledge that it is the responsibility of the Receiving Depository Financial Institution to make the necessary
arrangements for obtaining its automated clearinghouse information to ensure proper funds are deposited.
I may give notification of account changes, but I must allow UAM a reasonable time after receipt to make changes.
This agreement is in accordance with the rules and operating procedures of the Mid-America Payment Exchange.
Signature Date
Revised 3/28/2018
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
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
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.
Form
W
-
4
Department of the Treasury
Internal
Revenue
Service
E
mp
l
oyee
’
s
Withh
o
ldi
ng
All
owance
C
er
tifi
ca
t
e
subject to review by the IRS. Your employer may be required to send a copy of this form to the
IRS.
OMB No.
1545-0074
2018
1 Your first name and middle initial Last name 2 You
r
social securit
y
numbe
r
Home address (number and street or rural route)
3
Single Married Married, but withhold at higher Single rate.
Note:
If
married filing separately, check “Married,
but
withhold
at
higher Single
rate.”
City or town, state, and ZIP
code
4 If your last name differs from that shown on your social security
card,
check here. You must call 800-772-1213 for a replacement card.
▶
5 Total number of allowances you’re claiming (from the applicable worksheet on the following pages) . . .
6 Additional amount, if any, you want withheld from each paycheck . . . . . . . . . . . . . .
5
6
$
7 I claim exemption from withholding for 2018, and I certify that I meet both of the following conditions for
exemption.
•
Last year I had a right to a refund of all federal income tax withheld because I had no tax liability, and
•
This year I expect a refund of all federal income tax withheld because I expect to have no tax
liability.
If you meet both conditions, write “Exempt” here . . . . . . . . . . . . . . .
▶
7
Form W-4
(2018)
Future
developments. For the
latest
information about any future
developments
related to Form W-4, such as legislation
enacted after it was published, go
to
www.irs.gov/FormW4
.
Purpose. Complete Form W-4 so that your
employer can withhold the correct federal
income tax from your pay. Consider
completing a new Form W-4 each year
and
when your personal or financial
situation
changes.
Exemption from
withholding.
You may
claim exemption from withholding for 2018
if both of the following
apply.
•
For 2017 you had a right to a refund of all
federal income tax withheld because
you
had no tax liability, and
•
For 2018 you expect a refund of all
federal income tax withheld because
you
expect to have no tax
liability.
If you’re exempt, complete only lines 1, 2,
3, 4, and 7 and sign the form to validate
it.
Your exemption for 2018 expires February
15, 2019. See Pub. 505, Tax
Withholding
and Estimated Tax, to learn more
about
whether you qualify for exemption
from
withholding.
General Instructions
If you aren’t exempt, follow the rest
of
these instructions to determine the
number
of withholding allowances you should
claim
for withholding for 2018 and any
additional
amount of tax to have withheld. For regular
wages, withholding must be based
on
allowances you claimed and may not be a
flat amount or percentage of wages.
You can also use the calculator
at
www.irs.gov/W4App to determine your
tax withholding more accurately. Consider
using this calculator if you have a more
complicated tax situation, such as if
you
have a working spouse, more than one
job,
or a large amount of nonwage
income
outside of your job. After your Form
W-4
takes effect, you can also use
this
calculator
to see how the amount of
tax
you’re having withheld compares to your
projected total tax for 2018. If you use
the
calculator, you don’t need to complete any
of the worksheets for Form
W-4.
Note that if you have too much tax
withheld, you will receive a refund when you
file your tax return. If you have too little tax
withheld, you will owe tax when you file your
tax return, and you might owe a penalty.
Filers with multiple jobs or working
spouses. If you have more than one job
at
a time, or if you’re married and your
spouse
is also working, read all of
the
instructions including the instructions
for
the Two-Earners/Multiple Jobs Worksheet
before
beginning.
Nonwage income. If you have a large
amount of nonwage income, such as
interest or dividends, consider
making
estimated tax payments using Form
1040-
ES, Estimated Tax for Individuals.
Otherwise, you might owe additional
tax.
Or,
you can use the
Deductions,
Adjustments, and Other Income Worksheet
on page 3 or the calculator at
www.irs.gov/
W4App to make sure you have enough
tax
withheld from your paycheck. If you have
pension or annuity income, see Pub. 505
or
use the calculator at
www.irs.gov/W4App
to find out if you should adjust your
withholding on Form W-4 or W-4P.
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 Personal
Allowances Worksheet
Complete
this
worksheet on page 3 first to determine the
number of withholding allowances
to
claim.
Line C. Head of household please note:
Generally, you can claim head
of
household filing status on your tax return
only if you’re unmarried and pay more than
50% of the costs of keeping up a home
for
yourself and a qualifying individual. See
Pub. 501 for more information about
filing
status.
Line E. Child tax credit. When you
file
your tax return, you might be eligible
to
claim a credit for each of your
qualifying
children. To qualify, the child must
be
under age 17 as of December 31 and
must
be your dependent who lives with you
for
more than half the year. To learn more
about this credit, see Pub. 972, Child Tax
Credit. To reduce the tax withheld
from
your pay by taking this credit into
account,
follow the instructions on line E of
the
worksheet. On the worksheet you will
be
asked about your total income. For
this
purpose, total income includes all of your
wages and other income, including
income
earned by a spouse, during the year.
Line F. Credit for other dependents.
When you file your tax return, you might
be
eligible to claim a credit for each of your
dependents that don’t qualify for the
child
tax credit, such as any dependent
children
age 17 and older. To learn more about
this
credit, see Pub. 505. To reduce the tax
withheld from your pay by taking this
credit
into account, follow the instructions on line
F of the worksheet. On the worksheet, you
will be asked about your total income. For
this purpose, total income includes all
of
Separate
here and
give
Form
W-4
to
your
employer.
Keep
the
worksheet(s)
for
your
records.
▶
Whether you’re entitled to claim a certain number of allowances or exemption from
withholding is
Under penalties of perjury, I declare that I have examined this certificate and, to the best of my knowledge and belief, it is true, correct, and
complete.
Employee’s signature
(This form is not valid unless you sign it.)
▶
Date
▶
8 Employer’s name and address
(
Employer:
Complete boxes 8 and 10 if sending to IRS and
complete
boxes 8, 9, and 10 if sending to State Directory of New Hires.)
9 First date
of
employment
10 Employer
identification
number (EIN)
For Privacy Act and Paperwork Reduction Act Notice, see page 4.
Cat. No. 10220Q
Form
W-4 (2018)
Page 2
Form W-4 (2018)
your wages and other income, including
income earned by a spouse, during the year.
Line G. Other credits. You might be able
to reduce the tax withheld from your
paycheck if you expect to claim other
tax
credits, such as the earned income
tax
credit and tax credits for education
and
child care expenses. If you do so, your
paycheck will be larger but the amount
of
any refund that you receive when you file
your tax return will be smaller. Follow
the
instructions for Worksheet 1-6 in Pub. 505
if you want to reduce your withholding
to
take these credits into
account.
Deductions, Adjustments, and
Additional Income Worksheet
Complete this worksheet to determine
if
you’re able to reduce the tax withheld
from
your paycheck to account for your itemized
deductions and other adjustments
to
income such as IRA contributions. If
you
do so, your refund at the end of the year
will
be smaller, but your paycheck will
be
larger. You’re not required to complete
this
worksheet or reduce your withholding
if
you don’t wish to do
so.
You can also use this worksheet to figure
out how much to increase the tax
withheld
from your paycheck if you have a large
amount of nonwage income, such as
interest or
dividends.
Another option is to take these items
into
account and make your withholding more
accurate by using the calculator
at
www.irs.gov/W4App. If you use
the
calculator, you don’t need to complete any
of the worksheets for Form
W-4.
Two-Earners/Multiple Jobs
Worksheet
Complete this worksheet if you have more
than one job at a time or are married
filing
jointly and have a working spouse. If
you
don’t complete this worksheet, you
might
have too little tax withheld. If so, you
will
owe tax when you file your tax return
and
might be subject to a
penalty.
Figure the total number of allowances
you’re entitled to claim and any
additional
amount of tax to withhold on all jobs using
worksheets from only one Form W-4. Claim
all allowances on the W-4 that you or your
spouse file for the highest paying job in
your family and claim zero allowances
on
Forms W-4 filed for all other jobs. For
example, if you earn $60,000 per year
and
your spouse earns $20,000, you
should
complete the worksheets to determine
what to enter on lines 5 and 6 of your Form
W-4, and your spouse should enter zero
(“-0-”) on lines 5 and 6 of his or her Form
W-4. See Pub. 505 for
details.
Another option is to use the calculator
at
www.irs.gov/W4App to make your
withholding more
accurate.
Tip: If you have a working spouse and your
incomes are similar, you can check
the
“Married, but withhold at higher Single
rate” box instead of using this worksheet. If
you choose this option, then each
spouse
should fill out the Personal Allowances
Worksheet and check the “Married,
but
withhold at higher Single rate” box on Form
W-4, but only one spouse should claim any
allowances for credits or fill out
the
Deductions, Adjustments, and
Additional
Income Worksheet.
Instructions for Employer
Employees, do not complete box 8, 9, or
10. Your employer will complete these
boxes if necessary.
New hire reporting. Employers are
required by law to report new employees
to
a designated State Directory of New Hires.
Employers may use Form W-4, boxes 8, 9,
and 10 to comply with the new hire
reporting
requirement for a newly hired
employee. A newly hired employee is an
employee who hasn’t previously been
employed by the employer, or who was
previously employed by the employer
but
has been separated from such
prior
employment for at least 60
consecutive
days. Employers should contact
the
appropriate State Directory of New Hires
to
find out how to submit a copy of
the
completed Form W-4. For information
and
links to each designated State Directory
of
New Hires (including for U.S. territories),
go
to
https://www.acf.hhs.gov/css/employers.
If an employer is sending a copy of Form
W-4 to a designated State Directory
of
New Hires to comply with the new hire
reporting requirement for a newly hired
employee, complete boxes 8, 9, and 10 as
follows.
Box 8. Enter the employer’s name
and
address. If the employer is sending a
copy
of this form to a State Directory of New
Hires, enter the address where
child
support agencies should send
income
withholding
orders.
Box 9. If the employer is sending a copy
of
this form to a State Directory of New Hires,
enter the employee’s first date
of
employment, which is the date services
for
payment were first performed by
the
employee. If the employer rehired
the
employee after the employee had been
separated from the employer’s service
for
at
least 60 days, enter the rehire
date.
Box 10. Enter the employer’s employer
identification number (EIN).
Page 3
Form W-4 (2018)
{
{
}
Personal Allowances Worksheet (Keep for your
records.)
A
Enter “1” for yourself . . . . . . . . ................ . . . . ..
A
B
Enter “1” if you will file as married filing jointly . ................ . . . . ..
B
C
Ente
r
“1” if
y
ou will file as head of household .
................
.
.
.
.
..
C
•
You’re single, or married filing separately, and have only one job;
or
D Enter “1” if:
•
You’re married filing jointly, have only one job, and your spouse doesn’t work; or
D
•
Your wages from a second job or your spouse’s wages (or the total of both) are $1,500 or less.
E Child tax credit. See Pub. 972, Child Tax Credit, for more
information.
•
If your total income will be less than $69,801 ($101,401 if married filing jointly), enter “4” for each eligible
child.
•
If your total income will be from $69,801 to $175,550 ($101,401 to $339,000 if married filing jointly), enter “2” for each
eligible
child.
•
If your total income will be from $175,551 to $200,000 ($339,001 to $400,000 if married filing jointly), enter “1”
for
each eligible
child.
•
If your total income will be higher than $200,000 ($400,000 if married filing jointly), enter “-0-” . . . . . . .
E
F
Credit for other dependents.
•
If your total income will be less than $69,801 ($101,401 if married filing jointly), enter “1” for each eligible
dependent.
•
If your total income will be from $69,801 to $175,550 ($101,401 to $339,000 if married filing jointly), enter “1” for every
two dependents (for example, “-0-” for one dependent, “1” if you have two or three dependents, and “2” if you have
four dependents).
•
If your total income will be higher than $175,550 ($339,000 if married filing jointly), enter “-0-” . . . . . . . F
G Other credits. If
you have other credits, see Worksheet 1-6
of
Pub. 505 and enter the amount from that worksheet
here . . G
H Add lines A through G and enter the total here . . . . . . . . . . . . . . . . . . . . . .
▶
H
•
If you plan to itemize or claim adjustments to income and want to reduce your withholding, or if
you
have a large amount of nonwage income and want to increase your withholding, see the Deductions,
For
accuracy,
complete all
worksheets
that apply.
Adjustments, and Additional Income Worksheet
below.
•
If you have more than one job at a time or are married filing jointly and you and your spouse both
work, and the combined earnings from all jobs exceed $52,000 ($24,000 if married filing jointly), see
the
Two-Earners/Multiple Jobs Worksheet on page 4 to avoid having too little tax
withheld.
•
If neither of the above situations applies, stop here and enter the number from line H on line 5 of Form
W-4 above.
Deductions, Adjustments, and Additional Income Worksheet
Note: Use this worksheet only if you plan to itemize deductions, claim certain adjustments to income, or have a large amount of nonwage
income.
1 Enter an estimate of your 2018 itemized deductions. These 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. See Pub. 505 for details . . . . . . . . . . . . . . . . . . . . . .
1
$
2 Enter:
{
$24,000 if you’re married filing jointly or qualifying widow(er)
$18,000 if you’re head of
household
$12,000 if you’re single or married filing separately
}
. . . . . . . . . . . 2 $
3 Subtract line 2 from line 1. If zero or less, enter “-0-” . . . . . . . . . . . . . . . . . 3
$
4 Enter an estimate of your 2018 adjustments to income and any additional standard deduction for age
or
blindness
(see
Pub. 505 for information about these items) . . . . . . . . . . . . . . . .
4
$
5 Add lines 3 and 4 and enter the total . . . . . . . . . . . . . . . . . . . . . . 5
$
6
Enter an estimate of your 2018 nonwage income (such as dividends or interest) . . . . . . . . .
6
$
7 Subtract line 6 from line 5. If zero, enter “-0-”. If less than zero, enter the amount in parentheses . . . 7
$
8
Divide the amount on line 7 by $4,150 and enter the result here. If a negative amount, enter in parentheses.
Drop any fraction . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8
9 Enter the number from the Personal Allowances Worksheet, line H above . . . . . . . . . . 9
10
Add lines 8 and 9 and enter the total here. If zero or less, enter “-0-”. If you plan to use the
Two-Earners/
Multiple Jobs Worksheet, also enter this total on line 1, page 4. Otherwise, stop here and enter this
total
on Form W-4, line 5, page 1 . . . . . . . . . . . . . . . . . . . . . . . . .
10
Page 4
Form W-4 (2018)
Two-Earners/Multiple Jobs Worksheet
Note: Use this worksheet only if the instructions under line H from the Personal Allowances Worksheet direct you here.
1
Enter the number from the Personal Allowances Worksheet, line H, page 3 (or, if you used
the
Deductions, Adjustments, and Additional Income Worksheet on page 3, the number from line 10 of
that
worksheet) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
2 Find the number in Table 1 below that applies to the
LOWEST
paying job and enter it here. However, if you’re
married filing jointly and wages from the highest paying job are $75,000 or less and the combined wages for
you
and
your
spouse
are
$107,000
or
less,
don’t
enter
more
than
“3”
.
.
.
.
.
.
.
.
.
.
.
.
.
2
3 If line 1 is more than or equal to line 2, subtract line 2 from line 1. Enter the result here (if zero, enter
“-0-”)
and on Form W-4, line 5, page 1. Do not use the rest of this worksheet . . . . . . . . . . . .
3
Note: If line 1 is less than line 2, enter “-0-” on Form W-4, line 5, page 1. Complete lines 4 through 9 below
to
figure the additional withholding amount necessary to avoid a year-end tax
bill.
4 Enter the number from line 2 of this worksheet . . . . . . . . . . . 4
5 Enter the number from line 1 of this worksheet . . . . . . . . . . . 5
6 Subtract line 5 from line 4 . . . . . . . . . . . . . . . . . . . . . . . . . . 6
7 Find the amount in Table 2 below that applies to the HIGHEST paying job and enter it here . . . . . 7
$
8 Multiply line 7 by line 6 and enter the result here. This is the additional annual withholding needed . . . 8 $
9 Divide line 8 by the number of pay periods remaining in 2018. For example, divide by 18 if you’re paid every
2 weeks and you complete this form on a date in late April when there are 18 pay periods remaining in
2018. Enter the result here and on Form W-4, line 6, page 1. This is the additional amount to be
withheld
from each paycheck . . . . . . . . . . . . . . . . . . . . . . . . . . .
9
$
Table 1 Table 2
Married Filing Jointly All Others Married Filing Jointly All Others
If
wages from
LOWEST
paying job
are—
Enter
on
line 2 above
If
wages from
LOWEST
paying job
are—
Enter
on
line 2 above
If wages from HIGHEST
paying job are—
Enter
on
line 7 above
If wages from HIGHEST
paying job are—
Enter
on
line 7 above
$0 - $
5,000
5,001 -
9,500
9,501 -
19,000
19,001 - 26,500
26,501 - 37,000
37,001 - 43,500
43,501 - 55,000
55,001 - 60,000
60,001 - 70,000
70,001 - 75,000
75,001 - 85,000
85,001 - 95,000
95,001 - 130,000
130,001 -
150,000
150,001 -
160,000
160,001 -
170,000
170,001 -
180,000
180,001 -
190,000
190,001 -
200,000
200,001 and over
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
$0 - $
7,000
7,001 -
12,500
12,501 - 24,500
24,501 - 31,500
31,501 - 39,000
39,001 - 55,000
55,001 - 70,000
70,001 - 85,000
85,001 - 90,000
90,001 - 100,000
100,001 -
105,000
105,001 -
115,000
115,001 -
120,000
120,001 -
130,000
130,001 -
145,000
145,001 -
155,000
155,001 -
185,000
185,001 and over
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
$0 - $24,375
24,376 - 82,725
82,726 - 170,325
170,326 - 320,325
320,326 - 405,325
405,326 - 605,325
605,326 and over
$420
500
910
1,000
1,330
1,450
1,540
$0 - $7,000
7,001 - 36,175
36,176 - 79,975
79,976 - 154,975
154,976 - 197,475
197,476 - 497,475
497,476 and over
$420
500
910
1,000
1,330
1,450
1,540
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 who claims
no
withholding allowances;
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 aren’t required to provide
the
information requested on a form
that’s
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.
(a) Your spouse for whom you have been claiming an
exemption is divorced or legally separated from you, or claims
his or her own exemption on a separate certicate, or
(b) The support you provide to a dependent for whom you claimed
an exemption is expected to be less than half of the total support for the year.
OTHER DECREASES in exemptions or dependents, such as the death of a
spouse or a dependent, does not affect your withholding until next year, but
requires the ling of a new certicate by December 1 of the year in which
they occur.
You may claim additional amounts of withholding tax if desired. This will
apply most often when you have income other than wages.
You qualify for the low income tax rates if your total income from all
sources is:
(a) Single $11,737 to $15,200
(b) Married Filing Jointly $19,794 to $24,300
(1 or less dependents)
(c) Married Filing Jointly $23,822 to $30,500
(2 or more dependents)
(d) Head of Household/Qualifying Widow(er) $16,687 to $21,400
(1 or less dependents)
(e) Head of Household/Qualifying Widow(er) $19,892 to $24,300
(2 or more dependents)
STATE OF ARKANSAS
Employee’s Withholding Exemption Certicate
AR4EC
Arkansas Withholding Tax Section
P. O. Box 8055
Little Rock,
Arkansas 72203-8055
Print Full Name ________________________________________________ Social Security Number ____________________________________
Print Home Address _____________________________________________ City _____________________________State _____ Zip _________
Employee:
File this form with
your employer.
Otherwise, your
employer must
withhold state
income tax from
your wages without
exemptions or
dependents.
Employer:
Keep this certicate
with your records.
How to Claim Your Withholding
See instructions below
1. CHECK ONE OF THE FOLLOWING FOR EXEMPTIONS CLAIMED
a. You claim yourself. (Enter one exemption) ......................................................................1a
b. You claim yourself and your spouse. (Enter two exemptions) .........................................1b
c. Head of Household, and you claim yourself. (Enter two exemptions) .............................1c
2. NUMBER OF CHILDREN or DEPENDENTS. (Enter one exemption per dependent) ................. 2
3. TOTAL EXEMPTIONS. (Add Lines 1a, b, c, and 2)
If no exemptions or dependents are claimed, enter zero .............................................................. 3
4. Additional amount, if any, you want deducted from each paycheck. (Enter dollar amount) ......... 4
5. I qualify for the low income tax rates. (See below for details) ....................................................... 5
Please check ling status: Single Married Filing Jointly Head of Household
I certify that the number of exemptions and dependents claimed on this certicate does not exceed the number to which I am entitled.
Signature: ______________________________________________________________________________________Date: _________________
For additional information consult your employer or write to:
Number of Exemptions
Claimed
Yes No
TYPES OF INCOME - This form can be used for withholding on all types
of income, including pensions and annuities.
NUMBER OF EXEMPTIONS – (Husband and/or Wife) Do not claim more
than the correct number of exemptions. However, if you expect to owe more
income tax for the year, you may increase your withholding by claiming a
smaller number of exemptions and/or dependents, or you may enter into an
agreement with your employer to have additional amounts withheld. This is
especially important if you have more than one employer, or if both husband
and wife are employed.
DEPENDENTS – To qualify as your dependent (line 2 of form), a person
must (a) receive more than 1/2 of their support from you for the year, (b)
not be claimed as a dependent by such person’s spouse, (c) be a citizen
or resident of the United States, and (d) have your home as their principal
residence and be a member of your household for the entire year or be
related to you as follows: son, daughter, grandchild, stepson, stepdaughter,
son-in-law or daughter-in-law; your father, mother, grandparent, stepfather,
stepmother, father-in-law or mother-in-law; your brother, sister, stepbrother,
stepsister, half brother, half sister, brother-in-law or sister-in-law; your uncle,
aunt, nephew or niece (but only if related by blood).
CHANGES IN EXEMPTIONS OR DEPENDENTS – You may le
a new certicate at any time if the number of exemptions or dependents
INCREASES. You must le a new certicate within 10 days if the number
of exemptions or dependents previously claimed by you DECREASES for
any of the following reasons:
Instructions
AR4EC (R 12/20/16)
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Student Hiring Packet (University of Arkansas - Monticello)

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Completed 2 February 2021

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