E m p l o y e r s F o r T h e S e l f - E m p l o y e d |
| List of Forms/Instructions |
| Down Load All Forms and Instructions
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 Direct Deposit Form |
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| Complete this form only if you would like to have your payroll directly deposited into your bank account.You may choose to have your deposit made into one or two accounts. | |
| W-4 Form |
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| This form must be completed. Unless you tell us otherwise, we will assume that the number of exemptions you claim is the same for both federal and state tax purposes. | |
| I-9 Form |
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| This form must be completed. You must include a copy of one item on List A or one item from both List B and C as detailed on the back of the form. | |
| United Healthcare (Health
Insurance) |
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This form is for health insurance coverage. This benefit is paid with your pre-taxed funds. The enrollment form must be completed whether or not you elect to take advantage of the coverage. If you want the coverage, complete the entire form. Your coverage will be effective the first day of the month following thirty days of employment. If you do not want the coverage, you need only fill in your name, check the box to decline coverage, and sign the form. |
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| 401(k) Enrollment Form |
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This form is for participation in our 401(k) plan. You can elect to contribute up to 9% of your wages with a matching company contribution of up to 9%. All contributions are made with pre-taxed funds. Your contributions to the plan will start on the first day of the month after your start date. You must complete the form even if you do not choose to participate. |
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| Fortis Benifit (Disability
Insurance) Form |
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This form is for participation in our group long-term disability plan. All employees must participate in this benefit. This plan covers 60% of your taxable income up to a maximum amount of $4,000 per month. The maximum monthly premium is $30 and is paid with pre-taxed funds. |
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| BMA(Dental Insurance) Form |
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| This form is for group dental coverage and must be completed even if you do not elect to take advantage of the benefit. This benefit is paid with pre-taxed funds. | |
| Per Diem Eligibility Form |
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This form must be completed if you are temporarily working away from your primary home and plan to be reimbursed for meals and lodging. Your contract must be for less than one year in order to qualify. Please note, that while per diem reimbursement does not require you to submit receipts, you must complete a weekly expense report to document the days you are away from your primary home. |
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| Expense Report |
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