Employee Information/Update

Transcription

1 Employee Information/Update Employee Name: Local Union #: Cell or Home Number: Please print legibly-missing or illegible information will delay payroll processing. Print your complete name and mailing address for year end tax forms and payroll checks-if applicable. Provide proper identification and employment eligibility on I9 as outlined. Review, sign and date all attached forms. Union Payroll Agency 5430 Park Drive, Rocklin, CA P: (916) F: (916)

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4 Government of the District of Columbia Year D-4 Employee Withholding Allowance Certificate Your first name M.I. Last name Home address (number and street) Apartment number Social security number City State Zip code +4-1 Tax filing status Fill in only one: Single Married/domestic partners filing jointly Married filing separately Head of household 2 Total number of withholding allowances from worksheet below 3 Additional amount, if any, you want withheld from each paycheck Married/domestic partners filing separately on same return 4 If claiming exemption from withholding, read below and, if qualified, write EXEMPT in this box. I am exempt because: last year I did not owe any DC income tax and had a right to a full refund of all DC income tax withheld from me; and this year I do not expect to owe any DC income tax and expect a full refund of all DC income tax withheld from me; and I qualify for exempt status on federal Form W-4. If claiming withholding exemption, are you a full-time student? Yes No $ Signature Under penalties of law, I declare that I have completed this certificate and, to the best of my knowledge, it is correct. Employee s signature Date Employer Keep this certificate with your records. If 10 or more exemptions are claimed or if you suspect this certificate contains false information please send a copy to: Office of Tax and Revenue, 941 North Capitol St., NE, Washington, DC Attn: Compliance Administration # Detach and give the top portion to your employer. Keep the bottom portion for your records. Government of the District of Columbia D-4 Employee Withholding Allowance Worksheet Section A Number of withholding allowances a Enter 1 for yourself and b Enter 1 if you are filing as a head of household and c Enter 1 if you are 65 or over and d Enter 1 if you are blind e Enter number of dependents a b c d e f Enter 1 for your spouse/registered domestic partner if filing jointly f g Enter 1 if married/registered domestic partners filing jointly and your spouse/registered domestic partner is 65 or over and h Enter 1 if married/registered domestic partners filing jointly and your spouse/registered domestic partner is blind g h i Number of allowances Add Lines a through h and enter on Line 2 of the certificate. If you want to claim additional withholding i allowances, complete section B below. Section B Additional withholding allowances j Enter estimate of your itemized deductions j k Enter $2,000 if married/registered domestic partners filing separately; all others enter $4,000 k l Subtract k from j l m Multiply $1,675 by the number of allowances on Line i m n Divide l by m. Round to the nearest whole number. o Add Lines n and i and enter on Line 2 above. n o D-4 P1 Employee Withholding Allowance Certificate Revised 08/08

5 # Detach and give the top portion to your employer. Keep the bottom portion for your records. Who must file a Form D-4? Every new employee who resides in DC and is required to have DC taxes withheld, must fill out Form D-4 and file it with his/her employer. If you are not liable for DC taxes because you are a nonresident you must file Form D-4A. Certificate of Nonresidence in the District of Columbia, with your employer. When should you file? File Form D-4 whenever you start new employment. Once filed with your employer, it will remain in effect until you file an amended certificate. You may file a new withholding allowance certificate any time the number of withholding allowances you are entitled to increases. You must file a new certificate within 10 days if the number of withholding allowances you claimed decreases. How many withholding allowances should you claim? Use the worksheet on the front of this form to figure the number of withholding allowances you should claim. If you want less money withheld from your paycheck, you may claim additional allowances by completing Section B of the worksheet, Lines j through o. However, if you claim too many allowances, you may owe additional taxes at the end of the year. Should I have an additional amount deducted from my paycheck? In some instances, even if you claim zero withholding allowances, you may not have enough tax withheld. You may, upon agreement with your employer, have more tax withheld by entering on Line 3, a dollar amount of your choosing. What to file After completing Form D-4, detach the top portion and file it with your employer. Keep the bottom portion for your records.

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11 Safe Work Practices These Safe Work Practices are provided for your information and education. They are intended to provide you with basic safety and health information that will assist you in avoiding injury while performing your daily activities. These Safe Work Practices are from the educational section of the Injury Prevention Program of Union Payroll Agency Inc. and are required by Section 3203 of Title 8, the mandatory safety legislation of CAL OSHA. Your support in reading these Safe Work Practices and following them in your day to day activities is greatly appreciated. General Safety Guidelines 1. It is important that all employees report all work related injuries and illnesses to their immediate supervisor as soon as possible after they become aware of the injury or illness. 2. Everyone should exercise extreme care and consideration in the performance of their duties to see they do not cause injury to others or create work hazards which could cause injury to others. 3. No one should try to lift or move heavy/bulky objects which could cause injury to the back or other body parts. You are requested to seek assistance. 4. Personal tools, equipment, extension cords, chemicals or electrical heaters should not be brought to work without management authorization. 5. If necessary, use a fire extinguisher. If one appears to have been used without your knowledge, report it to the facilities management as soon as possible so it may be recharged or replaced. 6. When you become aware of a facility or equipment defect, report it to the facilities manager for proper corrective action. Failure to report faulty conditions may result in injuries. 7. Be sure all food or liquid spills are wiped up immediately rather than left for someone else. 8. Never attempt to repair electrical equipment or appliances while in service. Tag them out of service and notify proper authority to effect repair. 9. Cabinets can be very dangerous if used improperly. Opening two drawers simultaneously can cause a cabinet to crash to the floor. Whenever possible, cabinets should be bolted together in tandem, secured to the floor or wall. 10. Flammable liquids should always be stored in appropriate, closed containers. Large supplies should be stored in UL-Approved cabinets or other appropriate means described by the Fire Department. Flammable liquids should never be left unattended. Earthquakes can cause spills resulting in fire. 11. Due to the ever pending possibility of earthquakes, heavy objects should be stored on lower shelves while lighter and less dangerous items can be stored on middle and upper shelves.

12 12. Bookshelves, storage cabinets and other elevated storage areas should be well secured. Bolted to the floor, wall or unitized in such a way to reduce possibility of tipping during an earthquake. 13. Defective furniture, worn carpet, defective chairs, loose handrails or other facility defects which could contribute to an accident should be reported to building services for proper corrective action. If possible, remove object from service. 14. Everyone should take time to become educated regarding emergency procedures for responding to fires, earthquakes or first aid emergencies. 15. Exercise extreme caution during blackouts. Use your flashlight as necessary. Proper Lifting Techniques a. Posture: Your back and neck have natural curves which should be kept flexible. Good posture maintains those curves and reduces stress on you muscles, ligaments and the shock-absorbing discs between the bones in your spine. b. Plan: Lift mentally first, planning your route and the place you will put down the load. When the load is heavy or bulky, get help. Ask a co-worker or use equipment to ease the task. (Mechanical lift, hand truck, cart etc.) c. Lifting: Establish good footing as you approach the object you intent to lift. Bend your knees, not your back and get a good grip. Plan to hold the object close to your body. Tighten your stomach as you lift. Lift smoothly with your legs not your back. d. Moving: Stand straight as you move the object. Don t twist your body while lifting; rather, turn your feet. Keep your balance. If you have a problem, ask for help. Be sure of your footing and pathway. e. Putdown: Be equally careful when putting the object down. Reverse the steps for lifting. Avoid trying to reach above the shoulder level to put a heavy object away. f. Exercise: Maintain a healthy lifestyle. The lighter your own weight, the less weight you are lifting when you bend over to pick up objects. Doctors suggest walking as an exercise for your back and general health. Stay loose; Stay healthy. I HAVE READ THOROUGHLY AND UNDERSTAND UPA S SAFE WORK PRACTICES DOCUMENT. I WILL ALWAYS MAINTAIN SAFE WORK PRACTICES AS OUTLINED WHILE REPRESENTING UPA AND WILL REPORT ANY INFRACTION TO MY SUPERVISOR IMMEDIATELY. Date: Signature: Name (Please print):