EMPLOYEE SETUP FORM€¦ · $ Amount or % Deposited per Pay: _____ Account Type: Checking Savings *NOTE: You are allowed to make deposits to only two checking and two savings accounts.

Revision 1-2015 (Form 002-001)

EMPLOYEE SETUP FORM

Client Company: ___________________________________________________ Client #: __________

First Name_______________________________ MI_______ Last Name_____________________________________

Address_________________________________________________________ Phone No _______________________

City_______________________________________________________ State____________ Zip Code_____________

DOB ____/_____/_________ Social Security #: _______-______-___________ ☐ Male ☐ Female

Voluntary EEO Identification (optional)

☐ Hispanic or Latino ☐ White (not Hispanic or Latino) ☐ Asian (not Hispanic or Latino)

☐ Black or African American (not Hispanic or Latino) ☐ American Indian or Alaska Native (not Hispanic or Latino)

☐ Native Hawaiian or Other Pacific Islander (not Hispanic or Latino) ☐ Two or more races (not Hispanic or Latino)

**TO BE COMPLETED BY EMPLOYER**

Job Title __________________________ Hire Date _____/_____/________ Department______________________

Hourly Rate 1 __________ Hourly Rate 2 __________ Hourly Rate 3 __________ Hourly Rate 4__________

Salary __________________ WC Code__________ Employment Status: ☐ Full Time ☐ Part Time

Hours per Week: _______________ Pay Frequency: ☐ Weekly ☐ Bi-Weekly ☐ Monthly

☐ Semi-Monthly ☐ Quarterly

Revision 01-2015 (Form 003-007)

DIRECT DEPOSIT AUTHORIZATION

I (print name) ______________________________________ employed at _______________________________________ authorize Elite Payroll Solutions to electronically deposit, on my behalf to the account(s) below:

Add Change Delete

Bank Name: _____________________________________________________

Bank Account Number: ____________________________________________

ACH Routing Number: _____________________________________________

$ Amount or % Deposited per pay: _____________________

Account Type: Checking Savings

Bank Name: ____________________________________________________

Bank Account Number: ___________________________________________

ACH Routing Number: ____________________________________________

$ Amount or % Deposited per Pay: _____________________

Account Type: Checking Savings

*NOTE: You are allowed to make deposits to only two checking and two savings accounts. Most Credit Union deductions are considered one savings account. Attach a VOIDED check(s), copy of a check or a copy of the Financial Institution I.D. Card (for savings accounts) and verify the ACH bank routing number and bank account number for all of the account(s) listed above. Please allow 2-3 pay periods for processing.

I hereby authorize and agree that in the event that Elite Payroll Solutions deposits funds erroneously into my account, I authorize Elite Payroll Solutions to debit my account, not to exceed the original amount of the erroneous credit. If I change bank or bank accounts, I am fully responsible for immediately notifying the Payroll Department of the change.

Employee Signature: _______________________________________________ Date: ______________________

*** Incomplete or invalid information will delay the start of your direct deposit or savings amount(s) ***

Attach

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You can now access your Paycheck stubs and W-2 forms online!

Go to: https://login.elitepayroll.net/hrp/EmployeeLogin

1) Click the “Register” button

2) Fill out all registration fields as shown on the right. Note: Be sure to enter the Birth Date using the following format MM/DD/YYYY. You will then be emailed a temporary password to use with the Username created. Once logged in, you can reprint check stubs, W-2 information from previous years, and view current direct deposit accounts.

PLEASE HAVE YOUR SUPERVISOR CONTACT THEIR PAYROLL COORDINATOR

IF YOU ENCOUNTER ANY PROBLEMS REGISTERING OR LOGGING IN: (772) 220-8600

Access your paycheck information online

Here’s how!!

Copy OR Ctrl + Click >>> http://www.elitepayroll.net/

You should be looking at the above homepage!!

Before you proceed, please open another tab in your browser with the

email account you will be asked to provide, open and ready to go!

Left click >>>

The following screen will display with a few choices, left click on the red bordered option

>> Registration <<

The page below will be displayed next. Please fill out the requested information. Be sure to

add the birthdate in the following format MM/DD/YYYY.

After you’ve filled out the requested information, left click on the ‘Continue’ button.

You will be prompted that you will receive a verification email with your password to login.

** STOP **

** AT THIS POINT **

Move to the open tab that was opened previously with your email account open & ready.

Locate the email, <check the junk folder if you don’t see it>

Open the email & follow the instructions within.

Have your supervisor contact Michael Cruz should you happen to encounter any problems.

Rev 2/2/16

EMPLOYEE SEPARATION NOTICE

Please type or print

Employee Name: _____________________________________ Social Security #:_____________________ (Last), (First) (MI)

Client Company: _____________________________________________ Client #: ________________

Last Day Worked: ________________________ Date of Termination: _____________________________

Reason for Separation:

__ Employee voluntarily resigned, reason: ______________________________________ __ Lay-Off/Reduction in staff __ 90–day probation/unsatisfactory work performance __ Poor work performance Explanation: ____________________________________________________ __ Gross misconduct __ Failure to comply w/company policy/procedure __ Disregard for supervisor/co-worker/customer __ Insubordination __ Failure to do job __ Violation of Safety Policy __ Absenteeism/Tardiness __ Other ________________________________________________________________

Supervisor’s comments: _____________________________________________________________________________________

Was the employee paid? __ In lieu of notice If yes, amount __________________ for period ____/___ / ____ to ___/ ___/ ___ __ Severance If yes, amount __________________ for period ____/___ / ____ to ___/ ___/ ___ __ Vacation/PTO If yes, amount __________________ Supervisor Signature: ___________________________________ Date: ___________________

FOR ELITE PAYROLL SOLUTIONS USE ONLY

Date received: _______ Date Processed: ________ Form processed by: ______________________________

Employee Statement: I have not suffered any personal injuries during my employment at ___________________________________________ Employee Signature: ________________________________________________ Date: ___________________________

Employee unavailable for signature, copy mailed □ Employee refused to sign □

Forwarding Address for last pay check and W2’s : ________________________________________________________