Update Existing Employee

Company Name or Company ID*

Please ask your employer for this information.

Demographic Information

Name*

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 Information

Social Security Number or FEIN*

Employment status*

I am a W2 Employee
I am a 1099 Contractor

Federal Filing Status*

Please 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*

Primary Residence State*

Local Tax

Would you like to receive your pay via direct deposit?*

Yes
No

Direct Deposit Information

Bank Name (1)*

ABA Transit # (1)*

Account # (1)*

Account Type (1)*

Checking
Savings

Amount $ or % (1)*

Add a second bank?*

Yes
No

Bank Name (2)*

ABA Transit # (2)*

Account # (2)*

Account Type (2)*

Checking
Savings

Amount $ or % (2)*

Add a third bank?*

Yes
No

Bank Name (3)*

ABA Transit # (3)*

Account # (3)*

Account Type (3)*

Checking
Savings

Amount ($ or %) (3)*

Add a fourth bank

Yes
No

Bank Name (4)*

ABA Transit # (4)*

Account # (4)*

Account Type (4)*

Checking
Savings

Amount $ or % (4)*

Add a fifth bank?*

Yes
No

Bank Name (5)*

ABA Transit # (5)*

Account # (5)*

Account Type (5)*

Checking
Savings

Amount $ 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 Comments

Please let us know if you have any other questions, concerns or comments.

Demographic Information

Tax Information

Direct Deposit Information

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