Information

  • Audit Title

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Demographic Information

  • Primary store location

  • First Name

  • Middle Initial

  • Last Name

  • Address, City, State, and Zip code

  • Social Security Number

  • Phone Number

  • Birth Date

  • Hire Date

  • Gender and Race, this is for Equal Employment Opportunity reporting use only

Job Info

  • Job Title

Salary

  • Hourly Rate or Weekly Salary

  • Full-time

  • Part-time

Deductions

  • Uniform Deduction Amount

  • Additional uniform request, amounts vary by item

  • Please report any other deductions, such as child support, garnishments, etc., as soon as the court orders are received.

Taxes

  • Marital Status

  • Single

  • Married

  • Head of House

  • Number of allowances

  • Additional withholding, if any listed

Direct Deposit

  • Please have employee fill out direct deposit form and put in their file. Also, multiple deposits can be set up.

  • Name of bank and address

  • Net pay?

  • Or dollar amount? What dollar amount out of check

  • Or percentage amount? What percentage of check

  • Bank ABA/TR#

  • Employee bank account number

  • Comments?

  • This authorization will remain in full force until canceled in writing, or by Silver Mine Subs at anytime by their sole discretion. Silver Mine Subs and its payroll company are authorized to initiate credit entries into your bank account, furthermore you authorize debit entries or adjustments in the event of an error in connection with your payroll. If you wish to cancel your direct deposit, please do so in writing to both Silver Mine Subs and its payroll company.

  • Employee Signature

  • Select date

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.