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Step 1 of 4 - Application For Employment

are an Equal Opportunity Employer and is committed to excellence through diversity Please print or type. The application must be fully completed to be considered. Please complete each section, even if you attach a resume.
Personal Information
Name*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone Number
Mobile Number
Email Address*
Are You A U.S. Citizen?
- Yes
- No
If Selected For Employment Are You Willing To Submit to a Pre-Employment Drug Screening Test?
- Yes
- No
Position
Position You Are Applying For
Available Start Date
Date Format: MM slash DD slash YYYY
Desired Pay
Employment Desired
- Full Time
- Part Time
- Seasonal / Temporary
References
Name Title Company Phone
Employment History
Employer (1)
Job Title
Work Phone
Starting Pay Rate
Ending Pay Rate

Phone*
Message
RATE TABLES FOR WAGE CHART The rate tables listed below correspond to the letters in the Wage Chart on the front page. Use these to estimate the amount of withholding that will occur if you choose to use the wage chart. Compare this to your estimated income tax liability for your New Jersey Income Tax return to see if this is the correct amount of withholding that you should have. RATE “A” WEEKLY PAYROLL PERIOD (Allowance $19.20) ANNUAL PAYROLL PERIOD (Allowance $1,000) If the amount of taxable wages is: The amount of income tax to be withheld is: If the amount of taxable wages is: The amount of income tax to be withheld is: Over But Not Over Of Excess Over Over But Not Over Of Excess Over $ 0 $ 385 1.5% $ 0 $ 0 $ 20,000 1.5% $ 0 $ 385 $ 673 $ 5.77 + 2.0% $ 385 $ 20,000 $ 35,000 $ 300.00 + 2.0% $ 20,000 $ 673 $ 769 $ 11.54 + 3.9% $ 673 $ 35,000 $ 40,000 $ 600.00 + 3.9% $ 35,000 $ 769 $ 1,442 $ 15.29 + 6.1% $ 769 $ 40,000 $ 75,000 $ 795.00 + 6.1% $ 40,000 $ 1,442 $ 9,615 $ 56.35 + 7.0% $ 1,442 $ 75,000 $ 500,000 $ 2,930.00 + 7.0% $ 75,000 $ 9,615 $ 96,154 $ 628.46 + 9.9% $ 9,615 $ 500,000 $ 5,000,000 $ 32,680.00 + 9.9% $ 500,000 $ 96,154 $ 9,195.77 + 15.6% $ 96,154 $ 5,000,000 $ 478,180.00 + 15.6% $ 5,000,000 RATE “B” WEEKLY PAYROLL PERIOD (Allowance $19.20) ANNUAL PAYROLL PERIOD (Allowance $1,000) If the amount of taxable wages is: The amount of income tax to be withheld is: If the amount of taxable wages is: The amount of income tax to be withheld is: Over But Not Over Of Excess Over Over But Not Over Of Excess Over $ 0 $ 385 1.5% $ 0 $ 0 $ 20,000 1.5% $ 0 $ 385 $ 962 $ 5.77 + 2.0% $ 385 $ 20,000 $ 50,000 $ 300.00 + 2.0% $ 20,000 $ 962 $ 1,346 $ 17.31 + 2.7% $ 962 $ 50,000 $ 70,000 $ 900.00 + 2.7% $ 50,000 $ 1,346 $ 1,538 $ 27.69 + 3.9% $ 1,346 $ 70,000 $ 80,000 $ 1,440.00 + 3.9% $ 70,000 $ 1,538 $ 2,885 $ 35.19 + 6.1% $ 1,538 $ 80,000 $ 150,000 $ 1,830.00 + 6.1% $ 80,000 $ 2,885 $ 9,615 $ 117.31 + 7.0% $ 2,885 $ 150,000 $ 500,000 $ 6,100.00 + 7.0% $ 150,000 $ 9,615 $ 96,154 $ 588.46 + 9.9% $ 9,615 $ 500,000 $ 5,000,000 $ 30,600.00 + 9.9% $ 500,000 $ 96,154 $ 9,155.77 + 15.6% $ 96,154 $ 5,000,000 $ 476,100.00 + 15.6% $ 5,000,000 RATE “C” WEEKLY PAYROLL PERIOD (Allowance $19.20) ANNUAL PAYROLL PERIOD (Allowance $1,000) If the amount of taxable wages is: The amount of income tax to be withheld is: If the amount of taxable wages is: The amount of income tax to be withheld is: Over But Not Over Of Excess Over Over But Not Over Of Excess Over $ 0 $ 385 1.5% $ 0 $ 0 $ 20,000 1.5% $ 0 $ 385 $ 769 $ 5.77 + 2.3% $ 385 $ 20,000 $ 40,000 $ 300.00 + 2.3% $ 20,000 $ 769 $ 962 $ 14.62 + 2.8% $ 769 $ 40,000 $ 50,000 $ 760.00 + 2.8% $ 40,000 $ 962 $ 1,154 $ 20.00 + 3.5% $ 962 $ 50,000 $ 60,000 $ 1,040 + 3.5% $ 50,000 $ 1,154 $ 2,885 $ 26.73 + 5.6% $ 1,154 $ 60,000 $ 150,000 $ 1,390.00 + 5.6% $ 60,000 $ 2,885 $ 9,615 $ 123.65 + 6.6% $ 2,885 $ 150,000 $ 500,000 $ 6,430.00 + 6.6% $ 150,000 $ 9,615 $ 96,154 $ 567.88 + 9.9% $ 9,615 $ 500,000 $ 5,000,000 $ 29,530.00 + 9.9% $ 500,000 $ 96,154 $ 9,135.19 + 15.6% $ 96,154 $ 5,000,000 $ 475,030.00 + 15.6% $ 5,000,000 RATE “D” WEEKLY PAYROLL PERIOD (Allowance $19.20) ANNUAL PAYROLL PERIOD (Allowance $1,000) If the amount of taxable wages is: The amount of income tax to be withheld is: If the amount of taxable wages is: The amount of income tax to be withheld is: Over But Not Over Of Excess Over Over But Not Over Of Excess Over $ 0 $ 385 1.5% $ 0 $ 0 $ 20,000 1.5% $ 0 $ 385 $ 769 $ 5.77 + 2.7% $ 385 $ 20,000 $ 40,000 $ 300.00 + 2.7% $ 20,000 $ 769 $ 962 $ 16.15 + 3.4% $ 769 $ 40,000 $ 50,000 $ 840.00 + 3.4% $ 40,000 $ 962 $ 1,154 $ 22.69 + 4.3% $ 962 $ 50,000 $ 60,000 $ 1,180.00 + 4.3% $ 50,000 $ 1,154 $ 2,885 $ 30.96 + 5.6% $ 1,154 $ 60,000 $ 150,000 $ 1,610.00 + 5.6% $ 60,000 $ 2,885 $ 9,615 $ 127.88 + 6.5% $ 2,885 $ 150,000 $ 500,000 $ 6,650.00 + 6.5% $ 150,000 $ 9,615 $ 96,154 $ 565.38 + 9.9% $ 9,615 $ 500,000 $ 5,000,000 $ 29,400.00 + 9.9% $ 500,000 $ 96,154 $ 9,132.69 + 15.6% $ 96,154 $ 5,000,000 $ 474,900.00 + 15.6% $ 5,000,000 RATE “E” WEEKLY PAYROLL PERIOD (Allowance $19.20) ANNUAL PAYROLL PERIOD (Allowance $1,000) If the amount of taxable wages is: The amount of income tax to be withheld is: If the amount of taxable wages is: The amount of income tax to be withheld is: Over But Not Over Of Excess Over Over But Not Over Of Excess Over $ 0 $ 385 1.5% $ 0 $ 0 $ 20,000 1.5% $ 0 $ 385 $ 673 $ 5.77 + 2.0% $ 385 $ 20,000 $ 35,000 $ 300.00 + 2.0% $ 20,000 $ 673 $ 1,923 $ 11.54 + 5.8% $ 673 $ 35,000 $ 100,000 $ 600.00 + 5.8% $ 35,000 $ 1,923 $ 9,615 $ 84.04 + 6.5% $ 1,923 $ 100,000 $ 500,000 $ 4,370.00 + 6.5% $ 100,000 $ 9,615 $ 96,154 $ 584.04 + 9.9% $ 9,615 $ 500,000 $ 5,000,000 $ 30,370.00 + 9.9% $ 500,000 $ 96,154 $ 9,151.35 + 15.6% $ 96,154 $ 5,000,000 $ 475,870.00 + 15.6% $ 5,000,000
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

State of New Jersey - Division of Taxation Employee’s Withholding Allowance Certificate
1. SS#
Name
Address City State Zip
2. Filing Status: (Check only one box)
- Single
- Married/Civil Union Couple Joint
- Married/Civil Union Partner Separate
- Head of Household
- Qualifying Widow(er)/Surviving Civil Union Partner
4 Total number of allowances you are claiming (see instructions)
5 Additional amount you want deducted from each pay
6 I claim exemption from withholding of NJ Gross Income Tax and I certify that I have met the conditions in the instructions of the NJ-W4. If you have met the conditions, enter “EXEMPT” here
7 Under penalties of perjury, I certify that I am entitled to the number of withholding allowances claimed on this certificate or entitled to claim exempt status
Employee’s Signature
Date
Date Format: MM slash DD slash YYYY

▶ Complete Form W-4 so that your employer can withhold the correct federal income tax from your pay. ▶ Give Form W-4 to your employer. ▶ Your withholding is subject to review by the IRS
Enter Personal Information
(a) First name and middle initial Last name
Address City or town State ZIP Code
(b) Social security number
(c)
- Single or Married filing separately
- Married filing jointly (or Qualifying widow(er))
- Head of household (Check only if you’re unmarried and pay more than half the costs of keeping up a home for yourself and a qualifying individual.)
Complete Steps 2–4 ONLY if they apply to you; otherwise, skip to Step 5.
Complete Steps 2–4 ONLY if they apply to you; otherwise, skip to Step 5. See page 2 for more information on each step, who can claim exemption from withholding, when to use the online estimator, and privacy.
Complete this step if you (1) hold more than one job at a time, or (2) are married filing jointly and your spouse also works. The correct amount of withholding depends on income earned from all of these jobs. Do only one of the following. (a) Use the estimator at www.irs.gov/W4App for most accurate withholding for this step (and Steps 3–4); or (b) Use the Multiple Jobs Worksheet on page 3 and enter the result in Step 4(c) below for roughly accurate withholding; or (c) If there are only two jobs total, you may check this box. Do the same on Form W-4 for the other job. This option is accurate for jobs with similar pay; otherwise, more tax than necessary may be withheld . . . . . ▶ TIP: To be accurate, submit a 2020 Form W-4 for all other jobs. If you (or your spouse) have self-employment income, including as an independent contractor, use the estimator. Complete Steps 3–4(b) on Form W-4 for only ONE of these jobs. Leave those steps blank for the other jobs. (Your withholding will be most accurate if you complete Steps 3–4(b) on the Form W-4 for the highest paying job.)
If your income will be $200,000 or less ($400,000 or less if married filing jointly): Multiply the number of qualifying children under age 17 by $2,000 ▶
Multiply the number of other dependents by $500
Add the amounts above and enter the total here
(a) Other income (not from jobs). If you want tax withheld for other income you expect this year that won’t have withholding, enter the amount of other income here. This may include interest, dividends, and retirement income .
(b) Deductions. If you expect to claim deductions other than the standard deduction and want to reduce your withholding, use the Deductions Worksheet on page 3 and enter the result here
(c) Extra withholding. Enter any additional tax you want withheld each pay period
Under penalties of perjury, I declare that this certificate, to the best of my knowledge and belief, is true, correct, and complete.
Employee’s signature (This form is not valid unless you sign it.)
Date
Date Format: MM slash DD slash YYYY
Employer’s name and address
First date of employment
Date Format: MM slash DD slash YYYY
Employer identification number (EIN)
For Privacy Act and Paperwork Reduction Act Notice, see page 3.
Comments
This field is for validation purposes and should be left unchanged.

Apply Now

Step 1 of 4 - Application For Employment

Personal Information

Position

References

Employment History

State of New Jersey - Division of Taxation Employee’s Withholding Allowance Certificate

▶ Complete Form W-4 so that your employer can withhold the correct federal income tax from your pay. ▶ Give Form W-4 to your employer. ▶ Your withholding is subject to review by the IRS

Complete Steps 2–4 ONLY if they apply to you; otherwise, skip to Step 5.

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