Fill - Free fillable Three-In-One Application for Employment (Kallas Restaurant Accounting) PDF form

Three-In-One

Application for Employment

Published & Distributed by:

Applicant Information

Full Name:

Date:

Last

First

M.I.

Address:

Street Address Apartment/Unit #

City

State

ZIP Code

Phone1

Phone2

E-mail

Date Available: M T W Th F S S

Hours

Available

Desired Salary:

Position Applied for:

Are you a citizen of the United States?

YES NO

If no, are you authorized to work in the U.S.?

YES

Have you ever worked for this company?

YES NO

If yes, when?

Have you ever been convicted of a felony?

YES NO

If yes, explain:

Education – school most recently attended

Name: Address:

From: To: Currently enrolled?

YES NO

Did you graduate?

YES NO

References

Please list two persons, not related to you, whom you have known at least one year.

Full Name:

Years Aquatinted:

Company:

Phone:

Full Name: Relationship

Company:

Phone:

Previous Employment

Company: Phone:

Address: Supervisor:

Job Title: Starting Salary:$ Ending Salary:$

Responsibilities:

From: To: Reason for Leaving:

May we contact your previous supervisor for a reference?

YES NO

Company: Phone:

Address: Supervisor:

Job Title: Starting Salary:$ Ending Salary:$

Responsibilities:

From: To: Reason for Leaving:

May we contact your previous supervisor for a reference?

YES NO

I certify that my answers are true and complete, and documents presented as proof of identity and employment eligibility are genuine and

relate to me. I am aware that federal law provides for imprisonment and/or fines for any false documents in connection with this

employment eligibility verification form. If this application leads to employment, I understand that false or misleading information in my

application or interview may result in my release.

Signature: Date:

What will be your transportation to work? ____________How long will it take you to get from home to work? _____________

Do you have any physical limitations which may require accommodations? No Yes

Do you now have, or have you had, within the last six months, any contagious or communicable diseases, or gastro-intestinal

infections, or have you ever had hepatitis or salmonella? No Yes

*During the past 10 years, have you ever been convicted of a crime, excluding misdemeanors and traffic violations?

No Yes If yes, describe in full: __________________________________________

*A conviction will not necessarily bar you from employment.

Certain worker wages are eligible for tax credit to the employer. Please indicate whether you are one of the following:

On long term family assistance. Recipient of Temporary Assistance for Needy Families (TANF). A veteran. An

ex-felon. A vocational rehabilitation referral. A summer youth employee. A food stamp or SSI recipient.

Would you like to be paid by direct deposit or debit card if offered? Yes No

This Company is an equal opportunity employer. The Civil Rights Act of 1964 and State and Local laws

prohibit discrimination on the basis of race, color, religion, sex, or national origin. In addition, State and Local

laws prohibit discrimination on the basis of age with respect to individuals who are at least 40 years of age. If

is our policy to comply in full with these Acts and information requested on this application will not be used

for any purpose prohibited by law.

1. Lying on Application. - I certify that the information contained in this correct to the best of my knowledge and

understand that deliberate falsification on this application is grounds for dismissal in accordance with Company

policy.

2. Release Work Records. - I authorize release of my work references to give you any and all information concerning

my previous employment and pertinent information they may have, personal or otherwise, and release all parties

from all liability for any damages that may result from furnishing same to you.

3. At Will Employee. - I acknowledge that, if I become employed, I will be free to terminate my employment at any time

for any reason and company retains the same rights. No company representative has the authority to make any

contrary agreement.

4. Any Shift Availability. - I understand that I may be call on to work various shifts including midnights and weekends

and that refusal or unavailability to work such shifts may be grounds for termination.

5. Drug and Alcohol Free. - I understand that the employer operates a drug free establishment and that coming to

work under the influence of drugs or alcohol will be grounds for immediate termination.

6. Agree to Test. - I understand that the employer may randomly test for drugs or alcohol and that refusal on my part to

submit to testing may be grounds for immediate termination.

7. Theft. - I understand that any form of employee theft or dishonesty on my part will be grounds for immediate

termination as well as possible prosecution.

8. Best Service at All Times. - I pledge that, whatever position I may hold in the Company, I will do all that I can to

ensure that every guest receives the finest service possible regardless of race, age, sex, national origin, or minority

status. I will be helpful and courteous to customers and fellow employees.

9. Deductions from Check. - I hereby authorize the employer to deduct from my check the costs including

administrative costs of 1.Garnishments/Levies 2.Credit card fees on tips 3.Breakage/losses 4.Direct

Deposit fees 5.Uniforms 6.Advances 7.Walk-outs 8.Insurance 9.Duplicate W-2 forms 10.Check cashing

10. Sexual Harassment. - You will be fired for any type of harassment – sexual or otherwise of any workers or patrons

of this establishment. Inappropriate touching, language, comments, name calling, etc. is strictly prohibited.

I certify that I have read the above and this statement is signed free of any intimidation or fear of discharge or any

other repercussions.

Employee’s signature _______________________________________________Date______________________

STOP

To Be

Completed by

Employer

Interviewed by: Remarks:

Start Date: Pay Rate:

Department:

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) $

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)

Page 3

Step 2(b)—Multiple Jobs Worksheet (Keep for your records.)

If you choose the option in Step 2(b) on Form W-4, complete this worksheet (which calculates the total extra tax for all jobs) on only ONE

Form W-4. Withholding will be most accurate if you complete the worksheet and enter the result on the Form W-4 for the highest paying job.

Note: If more than one job has annual wages of more than $120,000 or there are more than three jobs, see Pub. 505 for additional

tables; or, you can use the online withholding estimator at www.irs.gov/W4App.

Two jobs. If you have two jobs or you’re married filing jointly and you and your spouse each have one

job, find the amount from the appropriate table on page 4. Using the “Higher Paying Job” row and the

“Lower Paying Job” column, find the value at the intersection of the two household salaries and enter

that value on line 1. Then, skip to line 3 . . . . . . . . . . . . . . . . . . . . . 1 $

2 Three jobs. If you and/or your spouse have three jobs at the same time, complete lines 2a, 2b, and

2c below. Otherwise, skip to line 3.

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

Add the annual wages of the two highest paying jobs from line 2a together and use the total as the

wages in the “Higher Paying Job” row and use the annual wages for your third job in the “Lower

Paying Job” column to find the amount from the appropriate table on page 4 and enter this amount

on line 2b . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2b $

c Add the amounts from lines 2a and 2b and enter the result on line 2c . . . . . . . . . . 2c

3 Enter the number of pay periods per year for the highest paying job. For example, if that job pays

weekly, enter 52; if it pays every other week, enter 26; if it pays monthly, enter 12, etc. . . . . . 3

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.)

Enter an estimate of your 2020 itemized deductions (from Schedule A (Form 1040 or 1040-SR)). Such

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

taxes (up to $10,000), and medical expenses in excess of 10% of your income . . . . . . . . 1 $

2 Enter:

{

• $24,800 if you’re married filing jointly or qualifying widow(er)

• $18,650 if you’re head of household

• $12,400 if you’re single or married filing separately

}

. . . . . . . . 2 $

3 If line 1 is greater than line 2, subtract line 2 from line 1. If line 2 is greater than line 1, enter “-0-” . . 3 $

4 Enter an estimate of your student loan interest, deductible IRA contributions, and certain other

adjustments (from Schedule 1 (Form 1040 or 1040-SR)). See Pub. 505 for more information . . . 4 $

5 Add lines 3 and 4. Enter the result here and in Step 4(b) of Form W-4 . . . . . . . . . . . 5 $

Privacy Act and Paperwork Reduction Act Notice. We ask for the information

on this form to carry out the Internal Revenue laws of the United States. Internal

Revenue Code sections 3402(f)(2) and 6109 and their regulations require you to

provide this information; your employer uses it to determine your federal income

tax withholding. Failure to provide a properly completed form will result in your

being treated as a single person with no other entries on the form; providing

fraudulent information may subject you to penalties. Routine uses of this

information include giving it to the Department of Justice for civil and criminal

litigation; to cities, states, the District of Columbia, and U.S. commonwealths and

possessions for use in administering their tax laws; and to the Department of

Health and Human Services for use in the National Directory of New Hires. We

may also disclose this information to other countries under a tax treaty, to federal

and state agencies to enforce federal nontax criminal laws, or to federal law

enforcement and intelligence agencies to combat terrorism.

You are not required to provide the information requested on a form that is

subject to the Paperwork Reduction Act unless the form displays a valid OMB

control number. Books or records relating to a form or its instructions must be

retained as long as their contents may become material in the administration of

any Internal Revenue law. Generally, tax returns and return information are

confidential, as required by Code section 6103.

The average time and expenses required to complete and file this form will vary

depending on individual circumstances. For estimated averages, see the

instructions for your income tax return.

If you have suggestions for making this form simpler, we would be happy to hear

from you. See the instructions for your income tax return.

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