To begin the on-boarding process of a new employee, please complete the form below. Our payroll team will reach out, if there are additional questions.
Employee Information
Employee Name *
Hire Date *
Employee's Email *
State Employee Works In *
Employee Address:
Street *
City *
State *
Zip Code *
Social Security Number
Date of Birth
Marital Status
Position Information
Position/ Job Title
Department
Pay Rate *
Pay Structure *
Employee Status *
Employee Classification *
Benefits
Please list all additional benefits employee will receive.
Vacation Days
Days per Year
Sick Days
Days per Year
PTO Days
Days per Year
Medical Benefits *
Date benefits start
Amount of deduction
401k Enrollment *
Date eleigible to contribute
Amount of contribution
Direct Deposit Information
Bank Name
Bank City
Bank State
Routing Transit #
Account #
Account Type
Amount to Deposit:
Entire Amount
Specific Dollar Amount
% of Net
Bank Name
Bank City
Bank State
Routing Transit #
Account #
Account Type
Amount to Deposit:
Entire Amount
Specific Dollar Amount
% of Net
Additional information will be completed by the employee through the on-boarding process.
Contact Information
Employer Name *
Contact Name *
Contact Role *
Contact Phone Number *
Email Address *
Thank you
Thank you for trusting CustomPay to handle all of your payroll needs. We will be in contact with you soon.