w e l c o m e  a b o a r d

p l e a s e  f i l l  i n  t h e  f o r m s  b e l o w

y o u r  i n f o r m a t i o n  w i l l  b e  k e p t  s e c u r e

t h a n k  y o u



New Employee or Contractor Information

Name *
Leave blank if not a business
Address *
Phone *
Enter the pay rate and terms agreed upon with Dr. Cruz-Davis or Joel Cruz-Davis
Today's Date *
Today's Date
Expected Start Date *
Expected Start Date

Direct Deposit Information

Name *
Complete this section only if you wish to split your deposit into a second account

For Employees Only


Please fill out Form W-4 https://www.irs.gov/pub/irs-pdf/fw4.pdf then print and submit it to Joel

Name *
Extra withholding, if any, that you would like taken out of each paycheck and submitted to the IRS on your behalf

You can use this Withholding Calculator to help project your tax liability https://apps.irs.gov/app/withholdingcalculator