Fill - Free fillable Student Payroll Packet Checklist Time Employment at UC (Ursinus College) PDF form

Student Payroll Packet Checklist

First

Time

Employment

at

UC

THIS

IS

MY

FIRST

JOB

ON CAMPUS. I

will

complete

the

following steps:

__

Complete Student Employment Contract

•

You

complete Section A

• Your employer must complete Section B

__

Complete W-4 Form

•

Use

your

home address

• International

Students-

use Ursinus College address

•

Sign

and date

the

form

__

Complete

1-9

form

• Complete Section 1.

Sign

and date the form.

• Bring

the

required forms

of

identification

to

Human Resources.

You

must

present your ORIGINAL forms

of

identification

to

Human Resources.

__

Complete Residency Certification Form

• Complete Section 1

• Sign and date

the

form

• The Business Office has listings

to

help you complete

the

"Resident

PSD

Code" information in Section 1.

__

Complete

the

Direct Deposit Authorization

form

• Complete this form and attach a voided check.

•

If

you are requesting direct deposit

to

your

savings account, attach a form

from

your bank showing account and transit

number

of

your bank.

All

of

the

above documentation must

be

turned

into

the

Human Resources Office

in

order

for

you

to

get paid

for

your

employment.

-----

URSINUS

COLLEGE

STUDENT EMPLOYMENT

CONTRACT

Your

first

responsibility

in

accepting

employment

ls

to

complete all

the

required documents. Please refer

to

the

appropriate

employment

check

list

included

with

the

student

employment

packet

to

assure all

documentation is completed.

Return

form

to

the

Human Resources office located

on

the

lower

level

of

Corson Hall.

SECTION

A:

STUDENT

INFORMATION (Print Clearly)

Name:

_____________________________

_

Campus Address:

_________________________

_

Phone Number:

__________________________

_

The

Higher Education

Act

of

1965, as amended (HEA),

in

Section 441(a) states

that

the purpose

of

the Federal Work

Study

(FWS)

Program is

to

promote

the

part-time

employment

of

students

who

are in need

of

earnings

to

pursue courses

of

study. As a

student

participating

in

part-time

work

at

Ursinus College,

whether

FWS

or

otherwise,

it

is

my

understanding

that

the college

will

not

permit

student

workers

to

work

during scheduled class times.

STUDENTSIGNATURE:

________________

Date:

_______

_

Expected Graduation Date:

________

_

SECTION

B:

POSITION INFORMATION (Completed

By

Employer)

Position Title:

________________

Hours

per

Week:

_______

_

Student is (check one):

___

New

to

position

___

Returning

to

position

Date

student

is

to

begin

work:

_____

(Contract

must

be received

by

Business Office/Payroll first)

Department Charged:

__________

Account Charged:

_________

_

Hourly Rate:

$

____

_

The Higher Education

Act

of

1965, as amended

(HEA),

in Section 441(a) states

that

the purpose

of

the

Federal Work

Study

(FWS)

Program

is

to

promote

the

part-time

employment

of

students

who

are in

need

of

earnings

to

pursue courses

of

study. As a

student

participating

in

part-time

work

at

Ursinus College,

whether

FWS

or

otherwise,

it

is

my

understanding

that

the college

will

not

permit

student

workers

to

work

during scheduled class times.

EMPLOYER

SIGNATURE:

_____________

Date:

_______

_

For Office Use Only:

Dept

Code:

PC

TS

File Number:

Rate Code:

click to sign

signature

click to edit

click to sign

signature

click to edit

Form W•4

Employee's Withholding Certificate

0MB

No.

1545-0074

►

Complete

Form

W-4

so

that

your

employer

can

withhold

the

correct

federal

income

tax

from

your

pay.

~@

20

Department

of

the

Treasury

►

Give

Form

W-4

to

your employer.

►

Your

withholding

is

subject

to

review by

the

IRS.

Internal

Revenue

Sesvice

Step 1:

(a) First name

and

middle

initial

I

Last

name

(bl

Social security number

Enter

Address

►

Does

your

name

match

the

Personal

name

on

your

social

security

Information

card?

If

not,

to

ensure you get

City

or

town, state, and ZIP code

credit

for

your earnings,

con

tact

SSA

at 800-772-1213

or

go

to

www.ssa.gov

.

(c)

0 Single

or

Married

filing

separately

0 Married filing jointly (or Qualifying widow(er))

D 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

qua

lifying 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:

Complete this step

if

you

(1)

hold more than one j

ob

at

a time,

or

(2)

are married filing jointly and your spouse

Multiple Jobs

also works. The correct amount

of

withholding depends

on

income earned from all

of

these jobs.

or

Spouse

Do

only

one

of

the

following.

Works

(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 .

►

D

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 compl

ete

Steps

3-4(b

} on

the

Form

W-4

for

the

highest paying job.)

Step

3:

Claim

Dependents

Step4

(optional):

Other

Adjustments

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

►

..,.

$

____

_

(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

3 $

include interest, dividends, and retirement income 4(a) $

f--'-'!..:.'-<..f-"-------

(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, l

declare

that

this

certificate,

to

the

best

of

my

knowledge

and

belief,

is

true, correct,

and

comp

lete.

►

Employee's signature

(Th

is form is not valid unless you sign it.)

►

Date

Employers

Only

Employer's name

and

address

First

date

of

employment

Employer identification

number

(E

IN)

For

Privacy

Act

and Paperwork Reduction

Act

Notice,

see

page

3.

Cat.

No

.

10

22

00

Form

W-4

(2020)

Foon

W-4

(2020)

Page2

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/ForrnW4.

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 liabili

ty

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.

Sett-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

Fonn

W-4 Instructions

for

Nonresident

Aliens, before completing

this

form.

Specific Instructions

Step 1(c).

Check

your

anticipated filing status. This will

detennine

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.

W.. Multiple jobs. Complete Steps 3 through 4(b)

on

only

m!imi

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

ch

i

ld

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.

Page3

Form

W-4

(2020)

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

1 $

that value on line

1.

Then,

skip

to

line 3 .

--'-------

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

-=$

_____

_

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

2

Enter

an

estimate

of

your

2020 itemized deductions {from Schedule A {Form 1040

or

1040-SR)). Such

deductions may include qualifying home mortgage interest, charitable contributions, state and local

taxes (up

to

$10,000), and medical expenses in excess

of

10%

of

your income

• $24,800

if

you're married filing jointly

or

qualifying widow(er) l

Enter: • $18,650

if

you're head

of

household

(

• $12,400

if

you're single

or

married filing separately

1

2

$

-'--------

.;::$

____

_

3

If

line 1 is greater than line 2, subtract line 2 from line 1.

If

line 2 is greater than line 1, enter

"-0-"

.

3

..;:.$

____

_

4 Enter

an

estimate

of

your student loan interest, deductible IRA contributions, and certain other

adjustments (from Schedule 1 {Form 1040

or

1040-SR)). See Pub. 505 for more information

4

..;::.$

____

_

5

Add

lines 3 and

4.

Enter the result here and in Step 4(b)

of

Form

W-4

.

5 $

Privacy

Act

and Paperwork

Reduction

Act

Notice.

We

ask

for

the

information

on

this

form

to

carry

out

the

Internal Revenue

laws

of

the

United States. Internal

Revenue

Code

sections

3402(1)(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

5eNices

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

PapeJWOrk Reduction

Act

unless the

form

displays a valid

0MB

control

number.

Books

or

records relating

to

a

form

or

its

instruct

i

ons

must

be

retained

as

long

as

their

contents

may

become

material in

the

administration

of

any

Internal Revenue law. Generally,

tax

returns

and

return

informat

i

on

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

i

ncome

tax

return.

Form W

-

4

(2020)

Page4

Married

Filina Jointly

or

Qualifving Widow(er)

Higher

Paying

Job

Lower Paying

Job

Annual Taxable Wage & Salary

Annual

Taxable

$0-

$10,000-

$20,000-

$30,000-

$40,000- $50,000-

$60,000- $70,000-

$80,000-

$90,000-

$100,000-

$110,000 •

Wage & Salary 9,999 19,999

29,999

39,999 49,999 59,999 69,999

79,999 89,999

99,999 109,999 120,000

$0-

9,999

$0

$220

$850

$900

$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

s·

ing e

or

M

arrie

"dFT

11na

Se

parate

y

Higher

Paying

Job

Lower Paying Job Annual Taxable Wage

& Salary

Annual

Taxable

$0-

$10,000- $20,000- $30,000-

$40,000-

$50,000 •

$60,000 -

$70,000-

$80,000-

$90,000-

$100,000- $110,000 •

Wage & Salary

9,999 19,999 29,999

39,999

49,999

59,999

69,999 79,999 89,999 99,999

109,999 120,000

$0

-

9,999

$460 $940 $1,020 $1,020 $1,470

$1,870 $1,870

$1,870 $1,870 $2,040

$2,040

$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

$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

$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

$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

Lower Paying

Job

Annual Taxable Wage & Salary

Annual

Taxable

$0-

$10,000-

$20,

000-

$30,000 ·

$40,000-

$50,000-

$60,000 •

$70,000-

$80,000-

$90,000 - $100,000-

$110,000 -

Wage &Salary

9,999 19,999 29,999

39,999

49,999

59,999

69,999

79,999

89

,

999

99,999

109,999

120,000

$0-

9,999

$0

$830

$930

$1,020

$1,020 $1,020

$1,480

$1,870 $1,870

$1,930

$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

$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

$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

Employment Eligibility Verification

Form

1-9

Department

of

Homeland Security

OM0No

. 1615-0047

U.S. Citizenship and Immigration Services

E'(p1

rcs

IOi3 l!202:?

►

START HERE: Read instructions carefully before completing this form. The instructions must be available, either

in

paper

or

electromcally,

during completion

of

this form. Employers are liable for errors in the completion

of

this form.

ANTI-DISCRIMINATION NOTICE: It

is

illegal to discnminate against work-authorized

ind

jvlduals. Employers

CANNOT

specify which document(s) an

employee

may

present

to

establi

sh

emp

loyment authonzation and idenbty.

The

refusal to hire

or

contu

nue

to

employ an indivcdual 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

1-9

no

later

than the first

day

of

employment.

but

not

before accepting a

job

offer.)

Last

Name (Family Name)

First

Name

(Given Name,

Middle Initi

al

Other Last Names Used (

if

any)

Address (Street Number

and

Name)

Apt.

Number

City

or

Town

State

ZIP Code

Date

of

Birth (mmlddlyyyy)

U.S. Social

Secunty

Number

Employee's E-mail Address

Employee's Telephone Number

[[D-m-11111

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):

D 1. A citizen

of

the United States

□

2. A noncitizen national

of

the United States (See instructions)

,__...

----

------

~--~

D 3. A lawful permanent resident (Alien Registration Number/USCIS Number

>:

D 4.

An

alien authorized

to

work

until (expiration date. if applicable, mm/dd/yyyy):

Some aliens

may

write

"N

I

A"

In

the

expiration date field. (See instructions)

Aliens authorized

to

work

must

provide

only

one

of

the following document numbers to complete Form

1-9

:

An

A

li

en Registration Number/USCIS Number

OR

Form

1-94

Admission Number

OR

Foreign Passport Number

1. Alien Reg

i,

st

f

al

ion NumberJUSCIS Number:

OR

2.

Form

1-94

Admission Number:

OR

3.

Foreign Passport

Number

:

Country

of

Issuance:

QR

Code -

Sec110n

1

Do No1 Wti

1e

In This

Spa

ee

s·Ignature

of

Employee Today's

Date

(mmlddlyyyy)

Preparer and/or Translator Certification (check one):

D I did

not

use a preparer

or

translator. 0 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

completlng 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

IToday's Date (mmlddlyyyy)

Last Name (Family Name) First

Name

(Given Name)

Address (Street Number

and

Name)

City

or

Town

State

ZIP Code

Employer Completes

Fonn

1-9

I0

l

'.?

l r.!

Ol':.l

USCIS

Employment Eligibility Verification

Form I-9

Department

of

Homeland Security

OMBNo

. 1615-00-t7

U.S. Citizenship and Immigration Services Expires IOl.l I

.'

2022

Section-2. Employer

or

Authorizet:1

1Re~re~e~tative~Revievi

1

and~Verificatipn· . . _ . -

(Employers

or

their authorlzeil.representatlve mustcompfete anil sign Section 2 wfthln 3 business

~ays

of

the

emptoy_ef!S-ff1t

i:J~y

of

~mployment

.•

You

must

physl~a(ly

examine.

one

document

from

LJstA-OR a

.:

comblnatlon·

of

one

document.fr-om

List B and one document

from

IJst C as listed,on

the

l.lsts

of

Acceptable·Documents.") • _ _

.-

~

• _

Last Name (Family Name) IFirst Name (Given Name)

IMJ.

1Citizensh1p/lmmigration Status

Employee

Info

from

Section

1

I

List

A OR

list

B AND

List

C

Document Title

Issuing Authority

Document Number

Expiration Date

(if

any) (mmlddlyyyy)

Expiration Date

(if

any) (mmlddlyyyy)

Expiration Date

(if

any) (mmlddlyyyy)

Document Title

QR

Code

• SetlKl<l$ 2 & 3

Issuing Authority

Additional

Information

Do

Not

Write n

ThlS

Spa~

Document Number

Expiration Date

(

if

any) (

mmlddlyyyy

)

Document

Tit

re

Issuing Authority

,,

"

Document Number

,;

Expiration Date /if any) (mmldd/yyyy)

Identity

and

Employment Authorization Identity Employment Authorization

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 (mmldd/yyyy):

_______

(See instructions for exemptions)

Signature

of

Employer

or

Authorized Representative

roday's

Date (mmldd/yyyy) I Title

of

Employer

or

Authorized Representative

Last

Name

of

Employer

or

Authorized

Representative

IFirst

Name

of

Employer

or

Authorized

Representative

IEmployer's Business or Organization Name

Employer's Business

or

Organization Address (Street

Number

and

Name) ICity or Town

IState

IZIP

Code

Section•

~.

"

Reverification

and

Retiir,es,

n;-o

:

be

~mpleted and-signea'by employer

or

:authorized.

rep_resentative.)

I

B. Date

of

Rehire

(If

applicable)

Last Name (Family Name)

First Name (Given Name)

Middle Initial

A.

New

Name

(if

applicable)

Date (mmlddlyyyy}

1

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.

Document Title I Document Number

IExpiration Date (if any) (mmlddlyyyy)

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 (mmlddlyyyy) Name

of

Employer

or

Authorized Representative

Page 2

of3

Fonn

1-9

10/21/2019

click to sign

signature

click to edit

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

Band

one selection from List C.

LIST A

Documents that Establish

Both Identity and

Employment Authorization

OR

1.

U.S. Passport

or

U.S. Passport Card

2.

Permanent Resident Card

or

Alien

Registration Receipt Card (Form 1-551)

3.

Foreign passport that contains a

temporary

1-551

stamp

or

temporary

1-

551

printed notation on a machine-

readable

imm

igrant visa

4.

Employment Authorization Document

that contains a photograph (Form

1-766)

5.

For a nonimmigrant alien authorized

to work for a specific employer

because

of

his

or

her

status:

a.

Foreign passport; and

b.

Form

1-94

or Form l-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.

6.

Passport from the Federated States

of

Micronesia (FSM)

or

the Republic

of

the Marshall Islands (RMI) with

Form 1-

94

or

Form 1~

94A

indicating

nonimmigrant admission under the

Compact

of

Free Association Between

the United States and the

FSM

or

RMI

LIST B

LISTC

Documents that Establish

Identity

AND

Documents that Establish

Employment Authorization

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,

he

ight, eye

color, and address

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 co,

or

, and address

3. School ID card with a photograph

4.

Voter's registration card

5.

U.S. Military card

or

draft record

6. Military dependent's ID card

7.

U.S. Coast Guard Merchant Mariner

Card

8.

Native American tribal document

9.

Driver's license issued

by

a Canadian

government authority

For persons under age 18 who are

unable to present a document

listed above:

10. School record

or

report card

11.

Clinic, doctor,

or

hospital record

12. Day-care

or

nursery school record

1.

A Social Security Account Number

card, unless the card includes one of

the following restrictions:

(1) NOT VALID FOR EMPLOYMENT

(2) VALID FOR WORK ONLY WITH

INS AUTHORIZATION

{3) VALID FOR WORK ONLY WITH

DHS AUTHORIZATI

ON

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

Amer

ican tnbal document

5.

U.S.

Cit

izen ID Card (Form

1-197

)

6.

Identification Card for Use

of

Resident

C1t

Izen

In

the United

States (Form 1-179)

7.

Employment authorization

document issued by the

Department

of

Homeland

Sec

unty

Examples

of

many

of

these documents appear in

the

Handbook for Employers (M-274).

Refer

to

the instructions for more information about acceptable receipts.

fo

nn 1-9 I

0!21120

19

Page 1

of1

CLGS-32-6 (8-111

RESIDENCY CERTIFICATION FORM

Local Earned Income Tax Withholding

TO

EMPLOYERS/TAXPAYERS:

This

fonn

is

to

be

used

by

employers and/or taxpayers

to

report essential information

for

the collection

and

distribution

of

Local Eamed Income Taxes.

This fonn

must

be utilized

by

employers when a

new

employee

is

hired

or

when

a current employee notifies employer

of

a name and/or address change.

STREET ADDRESS

(No

PO Box,

RD

or

RR)

SECOND LINE

OF

ADDRESS

CITY

MUNICIPALITY (City, Borough

or

Township)

COUNTY

STATE

ZIP CODE

RESIDENT

PSD

CODE

I I I I I I I

DAYTIME PHONE NUMB

ER

TOTAL RESIDENT E

IT

RATE

EMPLOYER BUSINESS NAME

(Use

Federal 10

Name)

Ursinus College

STREET ADDRESS

WHERE

ABOVE EMPLOYEE REPORTS

TO

WORK

(No

PO

Box

, RO or RR)

601

E. Main Street

SECOND LINE OF ADDRESS

ZIP

COD

E

CITY

STATE

Collegeville

PA

19426

PHONE NUMBER

610 409-3000

MUNICIPALITY (City, Borough

or

Township)

Collegeville

COUNTY

WORK

LOCATION

PSD

CODE

Montgomery

461201

WORK

LOCATION NON-RESIDENT

EIT

RATE

1.00%

CERTIFICATION

Under

penalties

of

pe~ury, I (we) declare

that

I (we) have examined this information, including

a'l

accompanying

schedules

and

statements and

to

the best

of

my

(our)

be

~ef, they

are

true, correct and complete.

SIGNATURE

OF

EMPLOYEE

IDATE (

MM/DDNYYY

)

IPHONE

NUMBER

EMAIL

ADDRESS

For

Information

on

obtaining

the

appropriate

MUNICIPALITY

(City,

Borough,

Township),

PSD

CODES

and

EIT

(Earned

Income

Tax) RATES,

please

refer

to

the

Pennsylvania

Department

of

Community

&

Economic

Development

website:

www.newPA.com

Urs

inus College

STUDENT

PAYROLL

DIRECT

DEPOSIT

AUTHORIZATION

FORM

Name:

_____________

Social Security

Number

:

________

(no

dashes)

Direct Deposit requires

full

net

pay

to

be

distributed

to

the

checking

or

savings account listed

below

.

IMPORTANT

NOTE

: You must

attach

a voided check

or

form

from

your

bank showing

your

account

number

and

transit/routing

number

for

the

bank.

Return all

information

to

the

Human Resources Office located on

the

lower

level

of

Corson Hall.

BANK

ACCOUNT

INFORMATION

Financial

Institution

Name, Address and Phone

Number

:

Net

Payroll

will

be

deposited

to

this

account:

Savings

Checking

Bank

Transit/Rout

ing

Number

(9 digits):

Action

to

be taken:

Start

Stop Change

Account Number:

Authorization:

I hereby

authorize

Ursinus College

(the

"College")

to

initiate

direct

deposit

into

the

account and financial

institution

listed above. Payroll

direct

deposits

will

be

made

to

the

account listed above

until

I choose

to

terminate

this

agreement

by

submission

of

a

new

Direct Deposit

Authorization

form

,

allowing

a

reasonable

amount

of

time

for

the

College

to

process such a change. Furthermore, I understand

that

termination

of

employment

with

the

College shall

constitute

sufficient

authorization

to

terminate

this

agreement.

Should funds be erroneously deposited

into

my

account, I authorize

the

College

to

debi

t

my

account

for

an

amount

not

to

exceed

the

amount

of

the

deposit.

EMPLOY

EE

SIGNATURE

:

______________

DATE

:

_________

_

Fill Online, Printable, Fillable, Blank Student Payroll Packet Checklist Time Employment at UC (Ursinus College) Form

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Fillable Student Payroll Packet Checklist Time Employment at UC (Ursinus College)

Fill Online, Printable, Fillable, Blank Student Payroll Packet Checklist Time Employment at UC (Ursinus College) Form

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