Add a New Employee Company Name or Company ID*Please ask your employer for this information.Demographic InformationName* First Last Address* Street Address Address Line 2 City State ZIP / Postal Code Email* Please provide the email address you wish to access the Employee Self Service portal. You will be able to retrieve your Paystubs and W2 from the Employee Self Service portal.Department Name/Number*If you are unsure please ask your employer. If your employer does not have specified departments please indicate by entering NO DEPT.Date of Hire* Date of Birth* Tax InformationSocial Security Number or FEIN*Employment status*I am a W2 EmployeeI am a 1099 ContractorFederal Filing Status*SingleMarriedPlease select your federal filing status please from the drop down.Federal Withholding Allowances*Please enter a value between 0 and 10.State Filing Status(if applicable)State Withholding(if applicable)Work State*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificPrimary Residence State*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificLocal TaxWould you like to receive your pay via direct deposit?*YesNoDirect Deposit InformationBank Name (1)*ABA Transit # (1)*Account # (1)*Account Type (1)*CheckingSavingsAmount $ or % (1)*Add a second bank?* Yes NoBank Name (2)*ABA Transit # (2)*Account # (2)*Account Type (2)*CheckingSavingsAmount $ or % (2)*Add a third bank?* Yes NoBank Name (3)*ABA Transit # (3)*Account # (3)*Account Type (3)*CheckingSavingsAmount ($ or %) (3)*Add a fourth bank Yes NoBank Name (4)*ABA Transit # (4)*Account # (4)*Account Type (4)*CheckingSavingsAmount $ or % (4)*Add a fifth bank?* Yes NoBank Name (5)*ABA Transit # (5)*Account # (5)*Account Type (5)*CheckingSavingsAmount $ or % (5)*Authorization* I hereby authorize my employer to directly deposit my pay in the bank account(s) listed above in the amounts/percentages specified. (If two accounts are designated, deposits are to be made in whole percentages of pay to total 100%.) I have attached a voided personalized check (checking accounts) or deposit slip (savings accounts) for each account specified above. No more than four accounts may be designated. This authorization is to remain in force until 10th Magnitude has received written authorization from me of its termination or change. Also, I hereby grant my employer the right to correct any such electronic funds transfer resulting from an erroneous over-payment by debiting my account to the extent of such over-payment.Additional Notes and CommentsPlease let us know if you have any other questions, concerns or comments. This iframe contains the logic required to handle AJAX powered Gravity Forms.