Employee Setup Form (1)

Form Type *

Add New Employee

Company Name *

Company Number

Who is your processor? *

Employee Number

SSN (xxx-xx-xxxx) *

Do you want to enter a Division/Location *

Yes

No

Division/Location

Do you want to enter a Dept *

Yes

No

Department

Employee First Name *

Employee Middle Name or Initial *

Employee Last Name *

Address *

City *

State *

Zip Code *

Work Email Address (optional)

Home Phone

Employment Information

Hire Date * +

Pay Type *

Salary

Hourly

Salary *

Salary Amount *

Hourly Rate *

Date of Birth

Which State will employee be working *

Do you use our Time Keeping System *

Yes

No

Filing Status *

Single

Married

Allowances Claimed on line 5 of (W-4) *

Do you need to add additional instructions *

Yes

No

Additional Instructions

Do you need to add garnishment information *

Yes

No

Include Attachment

Additional deductions *

Garnishment Instructions (Attach a copy of State letter above)

Do you want to enter direct deposit information *

Yes

No

*Note: To enroll for a Platinum Visa Pay Card you need to go to the Portland Payroll, Inc. web site and in the forms section, download the application "Platinum Visa Pay Card Enrollment Application" which is supplied in a PDF format. The form needs to be signed by the applicant and faxed to the number at the bottom of the application page.

Bank/Direct Deposit Information/Pay Card Information

PLEASE READ THESE INSTRUCTIONS CAREFULLY
Maximum number of Direct Deposit accounts is three (3). For Direct Deposit into checking account, please provide a copy of a voided check. For Direct Deposit into a savings account, please provide a deposit slip. For more than one account, fill in the fixed amounts or percentages. Direct Deposits may take up to one payroll cycle to become effective.

Please attach a voided check or fax to (503) 520-1385

Please select your processor *

	$ or %	Routing Number	Account Number	Bank Name
Checking 1	$ or %	Routing Number	Account Number	Bank Name
Checking 2	$ or %	Routing Number	Account Number	Bank Name
Checking 3	$ or %	Routing Number	Account Number	Bank Name

Note: If the employee is transferring part of their pay check into a savings account, please contact the employees bank to verify the savings account routing number.

	$ or %	Routing Number	Account Number	Bank Name
Savings 1	$ or %	Routing Number	Account Number	Bank Name
Savings 2	$ or %	Routing Number	Account Number	Bank Name
Savings 3	$ or %	Routing Number	Account Number	Bank Name

If you would like to recieve an email of the completed form, enter your email address below before you click on the submit button

Accruals

Does your company have an accrual plan? *

Yes

No

If yes, which plan? *

Portal

Do your EEs have online portals? *

Yes

No