Please use this form to add a new employee to the payroll service. If you have any questions please feel free to reach out to us directly at info@humanelements.us or call us at 866.808.7346.







Company ID *
Please ask your employer for this information.
Demographic Information
Name *
Address *
City

State

ZIP 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 Information
Please indicate your employment status. *
I am a W2 EmployeeI am a 1099 Contractor
Social Security Number or FEIN *

Federal Filing Status *
Please select your federal filing status please from the drop down.
Federal Withholding Allowances *
Please indicate how many withholding allowances you are claiming (0-99) and any additional amounts ($100 or 10%).
Work State *

Primary Residence State *

Local Tax

Direct Deposit Information
Would you like to receive your pay via direct deposit?
Yes
Direct Deposit Account Details*
Bank Name

ABA Transit #

Account #

Checking ( Y/N)

Amount ($ or %)

Please complete all fields for all accounts. If any fields are missing it could impact your ability to receive direct deposited funds to those accounts. Any changes made less than two business days prior to payroll processing will be effective on the following pay date.
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 overpayment by debiting my account to the extent of such overpayment.
Additional Notes and Comments
Please let us know if you have any other questions, concerns or comments.